


:owToExAMiNE For 

'^'LiFE Insurance 






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Copyright N" 



COPYRIGHT DEPOSIT. 



HOW TO EXAMINE 



FOR 



LIFE INSURANCE. 



BY 

FRANK RING, M. D., 

Medical Examiner for John Hancock Mutual Life Insurance Co., 

of Boston; Prudential Life Insurance Co., of Newark, N. J.; 

Security Trust and Life Insurance Co., of New York. 



i » • • 



3 -"^ -^ > OOJ 



ST. LOUIS: 
CHARLES D. WILLCOX, 

2313 Washington Ave. 
1901. 

V. 



THE LIBRARY OF 
CONGRESS, 

Two COPI£S ReCE»VED 

JUL. 22 1901 

Copyright entry 

af^.Z3,t9of 

CLASS t^XXe. N». 
COPY E. 



.''i^ 

H"^. 



e^ 



Copyright, 1901, 
Bt CHARLES D. WILLCOX. 



PREFACE. 

An effort has been made in this book to present the 
essentials of life-insurance examinations, and the impres- 
sions left upon an examiner in the field are here given. 

No attempt is made to speak ex cathedra or to assume 
a position in the exalted sphere or " solar- walk " occu- 
pied by the Medical Director. 

However, a free hand has been used to grasp authori- 
tative data wherever found. 

The instructions of the various Medical Directors have 
been canvassed, their public utterances before medico- 
insurance bodies have been gone over carefally, and 
many selections made. 

A large correspondence with Medical Directors, made 
necessary by the lapses and shortcomings of the writer, 
has been dissected with a view to presenting salient 
points, and prevent others from making like errors. In 
this connection, the writer wishes to pay tribute to the 
long-suffering patience,, and kindly toleration which he 
has observed as an inherent quality in the character of 
the Medical Director. 

It is estimated that the sum of nearly $5,000,000 is 
paid annually by the old-line companies to their medical 
examiners, and a correspondingly large amount is paid by 
the lodge and assessment companies. 

Life insurance is one of the few business enterprises in 
which the medical profession is consulted, and it should 
be the aim of the examiner to be worthy of this trust, by 
rendering valuable service in return. A rough computa- 



4 LIFE INSURANCE EXAMINATIONS. 

tion shows that the insurance mortality is better than the 
general mortality for the first five years, so that if the 
companies could get everybody to insure, they could 
readily dispense with the medical examiners. 

It should be the aim of the examiners to avail them- 
selves of the old and approved methods of diagnosis, and 
to be on the lookout for, and utilize every new method 
as it becomes authenticated as of value in making selec- 
tion of lives, so that the insurance mortality may be still 
further improved. 

In getting together the material for this little work, the 
writer has used what might be termed a composite form, 
representing the questions asked by the different com- 
panies. He has aimed to give the main features which 
the answers should embrace, in order to satisfy the require- 
ments of the home ofllce. 

With the hope that it may pro^e of some assistance to 
his co-workers in the field he submits it to their kindly 
consideration. 

The Author. 



COTEXTS. 

PAGE 

Selections of Lives for Assurance .... 7-8 
The Medical Examiner's Position and Oppor- 
tunity 8-11 

The Form. 

Occupation 14-16 

Habits and Intemperance 19-21 

Appendicitis 62-63 

Medical Examiner's Report 63-77 

Ur ANALYSIS 77-86 

The Urine as a Diagnostic Factor .... 86-87 

Examination of Women 90 

Confidential Reports 93 

Substandard Life Insurance 94 

Odds and Ends . . 102 

Index 107 



ESSENTIALS OF LIFE INSURANCE 
EXAniNATIONS. 



SELECTIONS OF LITES FOR ASSURANCE. 

Method of Examination. — While an examiner may 
be too easy in accepting the statements of a proposer 
about his own condition and his famil}- history, he may, 
on the contrary, be too rigid and suspicious. It is to be 
hoped that most people are fairly honest ; all will answer 
all inquiries to the best of their ability, naturally making 
the best ©f themselves, but not making any 'attempt at 
concealment or deception. I have known cases, however, 
in which the examiner has approached his task somewhat 
in the manner of a detective officer, treating the appli- 
cant as though he were bent on deceiying the examiner, 
and generally conducting the examination in a way which, 
though sometimes excusable or even necessary in the ex- 
amination of military recruits or suspected malingerers, 
can very rarely be necessary in examinations for life 
assurance. Especially is delicacy and tact required when 
the subject is a woman. In these cases personal inspec- 
tion must necessarily be less minute than in the case of 
male applicants (unless, of course, the examiner sees 
some very special reason for searching inquiry), and 
cross-examination of the statements of a female pro- 
poser cannot usually be pushed so far as it may 
properly be in the case of a man. The fact that a 
woman cannot usually be so rigidly examined as a man 



8 LIFE INSURANCE EXAMINATIONS. 

is recognized by the offices, and is one of the reasons why 
in some companies a small extra premium is required in 
the case of all female lives. — By Wm. Hughes^ F, /. A. 
of the Prudential Insurance Co, of England, 

The uses of a form for the report of medical examina- 
tions may be summed as follows: (1) The form is useful 
as a guide to the medical examiner; (2) it specifies the 
points to which his attention should be specifically 
directed; (3) it allows a proper estimate to be made of 
the applicant's health; (4) it gives useful indications 
for re-insurance ; and (5) it serves as a basis for statistics. 

In filling up the form, accuracy should be constantly 
aimed at; because, if questions are left unanswered, or 
not answered correctly, or answered in the wrong space, 
the application will be returned for correction. This will 
call for a letter by the Medical Director, asking for 
further information, and the medical examiner will be, 
practically, called upon to do his work over again. He 
will have the extra trouble of seeking the applicant 
again, and asking him to sign additional papers, which 
may call for hesitation on the part of the applicant, and 
he may decline to sign, from some motive intervening 
between the doctor's two visits. All of this trouble 
might have been avoided by the exercise of due care in 
the first instance. 

THE MEDICAL EXAMINER'S POSITION AND OPPOR- 
TUNITY. 

The examination of an applicant for life assurance dif- 
fers, of course, very materially from the ordinary exam- 
ination of a patient seeking relief from pain or the cure 
of disease. A patient is usually eager to assist his 



LIFE INSURANCE EXAMINATI<^NS. » 

adviser by detailing his symptoms and affording every 
information that the adviser may require. He does not 
shrink from the most minute inspection, and readily 
answers the most delicate questions that may be put to 
him. The applicant for assurance, on the other hand, 
will often do nothing, or as little as possible, to assist 
the examiner in the discovery of defects, and resents as 
impertinence questions as to his condition and habits, 
which he would gladly answer if he were seeking relief 
from suffering. He naturally wishes to make the best of 
himself, and is unwilling to believe that he is otherwise 
than physically perfect. The examiner, therefore, has 
to adopt methods of questioning an applicant somewhat 
differing from those he would adopt in the examination 
of a patient. The report which he is to make being solely 
for the guidance of the office, it is not desirable that he 
should inform the applicant of the result of his examina- 
tion. If he finds any defects he should not mention 
them to the applicant, and, on the other hand, if he finds 
everything satisfactory, it is not desirable that he should 
say so. The applicant is very likely to say at the con- 
clusion of the examination, '^ Well, Doctor, I suppose I 
am all right — you will recommend the office to accept 
me?" But even if this be actually the case, the doctor 
will do well to avoid answering the question. For the 
office may see fit to decline the proposer, or to require an 
increased premium on other than medical grounds, and 
if the examiner has announced to examinee his intention 
of making a favorable report, it may cause some embar- 
rassment. To such a question the doctor should reply 
that the report is made confidentially to the office, and 
that he makes it a rule not to inform applicants of the 



10 LIFE INSURANCE EXAMINATIONS. 

result, good or bad. This will, of course, be of service 
to the doctor in those cases where the result of the exam- 
ination is unsatisfactory. The same reply should of course 
be given to the agent of the company, if he should be so 
unwise as to inquire of the doctor what report he has 
given. — Wm. Hughes, F, I. A. 

It would be impertinent for me to make any remarks 
here on the actual conduct of the examination, so far as 
the purely medical and technical part of it is concerned. 
The examiner uses his medical learning, skill and ex- 
perience, and in discovering the actual state of the organs, 
the health and constitution of the applicant, and fills in 
the details on the form supplied, for the information and 
consideration of the principal medical adviser of the board 
of directors. There are, however, some other points to 
which the examiner has to direct his attention, on which 
I may be permitted to make some remarks. These are 
principally the history of past illness, the family history 
and the important questions of habits. With regard to 
the first two, the examiner is dependent almost entirely 
upon the personal statements of the proposer. If the 
examiner accepts these too readily, he is liable to be 
misled. It must be the experience of most examiners 
that applicants on being questioned as to past illnesses 
will frequently assert that they have never been ill — 
" never taken a bottle of medicine in their lives'' — or 
have never had anything worse than a cold, a headache 
or a toothache. And yet in such cases a little quiet talk 
and an adroit question or two will sometimes result in re- 
calling to the applicant's memory some occasions in 
which he has had to seek medical advice, and on pursuing 
the subject it may result in the discovery of some cir- 



LIFE INSUBANCE EXAMINATIONS. 11 

cumstance which may materially affect the examiner's 
opinion. 

Full Name. — This should be self-explanatory, but as a 
matter of fact, examinations are being constantly received 
and as regularly sent back for amendment, in which only 
the initials of the first name are given. 

The time and energy which is lost in remedying this 
oversight, which is entirely due to carelessness, might be 
employed to good advantage and yield a substantial 
return to the doctor and save many imprecations and 
much worry to the agent, where hopes of collecting a 
premium are thereby delayed, if not ruined. Its impor- 
tance becomes evident as a means of identification, both 
before and after death. Frequently applicants will say 
that they have never been postponed or rejected by any 
company, but when the records of the Medical Directors' 
Association show the full name, place and date of birth, 
as well as family history and minute personal description, 
all doubt as to identity will be dispelled. 

Place of Birth. — This calls for the town and State, 
and if possible for the county, and is an additional link 
in the chain of identification, and also much appreciated 
by the companies in its^bearing on statistics, a matter dear 
to the actuary's heart. 

Date of Birth. — Be sure the exact day, month and year 
of birth is given, the medical examiner's statement be- 
ing compared at the home oflSce with the same item on 
the applicant's statement to the agent. Any disagree- 
ment will call forth correspondence which may necessitate 
a great deal of extra work on the part of the examiner in 
seeking out and finding the applicant to have the matter 
corrected. In country practice particularly, due care to 



12 LIFE INSURANCE EXAMINATIONS. 

this detail will save man}^ a long trip, for the doctor 
should be exact in this matter, so that the error may not 
be charged to him. The matter of age becomes one of 
dollars and cents. If an applicant is younger than the age 
at which he was insured, he is deprived of the increased 
amount to which his premium would entitle him at his 
true age. If he is older, the company insuring him is 
liable for a larger amount than would have been the case 
had his age been correctly given. 

Residence. — This item should state the town, county 
and State, and, simple as it may seem, correspondence is 
sometimes had to settle a dispute between agents hold- 
ing contracts in adjoining territory. 

The writer once examined an applicant at the Planters' 
Hotel in St. Louis, and upon the authority of the appli- 
cant's statement that this hotel was his home, it was so 
stated in the examination paper. Subsequently, when the 
agent of the company in Chicago learned of the issuance 
of the policy, he sent information to the home office that 
this applicant lived at St. Elmo, Illinois, and hence came 
under the jurisdiction of the Chicago agent for the collec- 
tion of renewal premiums. To adjust the difficulty, it 
was necessary for the superintendent of agencies to make 
a trip to personally investigate and decide the question. 
The residence of the applicant includes not only his home, 
but also the location of the house and the territory sur- 
rounding. In this view, is his home situated in a healthy 
location? That is, are there any malarial or other dele- 
terious influences at work which will affect his good health 
and longevity? In this connection the examiner should, 
as far as possible, give the company the benefit of what- 
ever knowledge he may possess regarding the sanitary 



LIFE INSURANCE EXAMINATIONS. 13 

conditions of that part of the country at large in which he 
may reside, as well as the characteristic and particular 
classes of diseases peculiar to it. 

In the case of an examination made away from the 
home-city of the applicant, a close inspection will follow 
before the policy is issued, and the examiner should, 
hence, be on his guard, for obvious reasons, and make 
more than a careful examination. 

Present Occupation. — Exact information on this point 
is essential if a general term is used to describe an occupa- 
tion, such as clerk, salesman, mechanic, driver, teamster, 
cooper, etc. , the line of business in which the applicant is 
engaged must be added. 

When technical terms are used, such as rougher, presser, 
cutter, roller, kilnman, electrician, or any other term that 
designates the duties of the party, he should invariably ex- 
plain exactly what such duties are. Persons engaged in 
the following occupations are not regarded as desirable 
risks: Barkeepers, beer-bottlers, brewers (except those 
employed in the office or owning the brewery), cartridge 
makers, cotton factory operatives (unless foreman or 
superintendent), electric light or telephone linemen, file- 
finishers, file-grinders, glass-blowers, glass-gatherers, grain 
elevator employee, grind<erof edge tools, handler or maker 
of explosives, horse trainer, laborer (common), liquor 
dealer, retail lumberman (in woods), miner (except a 
foreman or superintendent), quarryman, raftsman, sailor 
(common), saloon-keeper, sawyer (knot), section hand, 
railroad and submarine operator, Turkish bath employee, 
telephone inspector, target man, well-digger, wrecking 
train laborer, zinc or lead works employee. 

There are certain occupations more or less hazardous 



14 LIFE INSURANCE EXAMINATIONS. 

because of the liability to accident or disease. This in 
the increased hazard is compensated for by an increased 
premium, base-ball players, bridge builders (large iron 
stretchers), engineer or officer of lake or sea vessels (first- 
class passenger vessels no extra), electric light trimmer, 
electric employees handling live wires, engineer or fireman 
of stationary engine (below the level of the ground), 
fisher (sea), foreman or superintendent of mines under 
ground, file-finisher, iron-workers (subject to extremes of 
heat), polishers (using emery wheel), stone-cutter, sawyer, 
buzz sawyer (circular), railroad employees — brakeman, 
freight, coal or mixed; conductor of freight, conductor of 
coal or mixed train ; engineer of locomotive, fireman, switch- 
man, coupler, yardmaster, active yardman. Before leaving 
the question of occupation, the examiner should thoroughly 
understand and describe the character of the surround- 
ings, the tools used, the atmosphere and temperature of 
the workshop, of the danger of systemic poisoning, the 
quantity of dust in the air, the diseases to which the workers 
are especially predisposed, and their liability to accident. 
The occupation of merchant may be differently interpreted 
by different people in various parts of the country, and 
may not only include his legitimate business, but may be 
used to cover an illegitimate occupation, or a highly objec- 
tionable or hazardous one ; for instance, the ordinary 
country merchant sometimes sells powder, and frequently 
has in connection with his store, a bar for the retailing of 
liquors. — Prudential Instructions. 

OCCUPATION. 

Occupation, Habits, and Mode of Life. — The occupa- 
tion may be either injurious in itself or of such a nature 



LIFK INSURANCE EXAMINATIONS. 15 

that no amount of precaution can make it harmless, or it 
may be injurious on account of its surroundings, or of the 
want of precaution on the part of the applicant, or on 
account of the temptation to bad habits to which it leads. 
But it may happen, and sometimes does, that a traveling 
salesman for a liquor house is a much better risk than a 
traveling salesman for a dry goods house. There is al- 
most nothing so hard to get information about as the 
habits of a man. Often he has the reputation of being 
temperate, and still he may die from the effects of alco- 
hol, because he has never been seen under its influence. 
On the other hand, he may be judged too severely, be- 
cause it has become known that once in a while he takes 
too much. A man is less liable to impair his constitution 
if he takes too much once in a while than he who never 
takes too much but takes a considerable amount regularly. 
The great danger in the first case is that the intervals be- 
tween the excesses are likely to become shorter, especially 
in young men when they take to drinking whisky. 
Although excesses in eating are not so common, and the 
immediate effects are not so injurious, still we know that 
many people shorten their lives by gourmandizing. An 
excessive amount of nourishing food taken daily is inju- 
rious after middle life, is apt to derange the digestive 
organs, and disturb the metabolism ; it causes excessive 
deposits of fat in the subcutaneous tissue and in the vital 
organs. 

The dangers arising from occupations or bad habits 
are, of course, greater for those who have an inherited or 
acquired tendency to certain diseases. To have a well 
established business and not be harassed by family or busi- 
ness cares is conducive to health and longevity ; while the 



16 LIFE INSURANCE EXAMINA I IONS 

constitution that under ordinary circumstances would 
have lasted many years longer, often breaks down at once 
under unusual strain, as in times of great political or re- 
ligious excitement many people become insane who would 
not be thus affected in more tranquil times. — Dr, Jos. 
Kuchei\ Medical Director^ Germania Life, 

The saloon-keeper is exposed to late hours of business, 
to confinement in an atmosphere more or less heated and 
impure, especially toward night, and, above all, to the ever- 
present temptation to over-indulgence in intoxicating 
drink. These causes seem to carry with them a largely 
increased liability to consumption, and to disease of every 
vital organ. 

Former Occupation. — This is asked to afford an index 
to any impairment which may have been contracted while 
applicant was engaged in an unusual occupation. 

Do you contemplate a change of residence or occupation? 

The answer to this question sometimes throws light upon 
some latent trouble, which might not be disclosed unless 
the applicant was adroitly led to incriminating response. 

Have you ever sought a change of climate or occupation 
on account of your health ? 

The examiner is often put on his guard by this response, 
as to the remaining effects of the former diagnosis of 
threatened or beginning phthisis or rheumatism. 

Are you now in good health ? 

This is a corollary to the preceding questions, and some- 
times causes the applicant to take the doctor into his 
confidence, to the benefit of the company. 

Have you been obliged to consult a doctor at any time 
during the last ten years? If so, when, and for what? 

An afllrmative answer to this question should be fol- 



LIFE INSURANCE EXAMINATIONS. 17 

lowed by a relation of all essential details of each spell 
of sickness of which the applicant may have complained, 
giving duration, severity, and sequelae. 

When^ and for ivhat, did you last consult a doctor? 

Notwithstanding a negative answer to the preceding 
question, applicants will often give an important history 
of previous illness dating within a short time of the ex- 
amination. 

Are you now under a doctor's care? If so, for what? 

While this is self-explanatory, the failure to give the 
essential details, often occasions correspondence which 
might be prevented, by supplying the probable diagnosis, 
cause, symptoms and prognosis of the affection of which 
the applicant complains. 

If any disease is active the applicant is not insurable. 

A sufficient length of time must elapse to show that he 
has returned to a condition of health in all cases where 
the sickness is curable. 

Name and residence of your usual medical attendant 9 

This affords a means of enlightenment on many points 
which might otherwise remain obscure, and is a factor in 
the assurance as well as settlement of many policies. 

Do you use ardent spirits, wines, or liquors? If so, to 
what extent — average quantity each day? 

This is one of the most perplexing questions to be 
answered, and probably one of the most important. It 
should be remembered that an excessive drinker will 
rarely admit the fact. 

The denial of excess may be made innocently, the ap- 
plicant not knowing that the amount consumed is exces- 
sive. Hence, the average quantity used daily of malt 
liquors, wines and spirits will determine the point. If 



18 LIFE INSURANCE EXAMINATIONS. 

there is intention to deceive, no reliance can be placed 
upon any statements made by the applicant. It is ad- 
visable to use extra effort to develop the facts relating to 
this point, and some companies are so strict in this matter 
that they authorize the examiner to invoke the aid of the 
" Inspection Department " to gather information relating 
to it direct to the company. It has been said that a daily 
use of liquors to a given amount of absolute alcohol may 
be allowable ; but it is evident that no unvarying rule 
can be established. Some individuals can consume more 
others less, without apparent harm. Hence, each case 
must be considered on its merits, but no applicants are 
desired who use alcohol in any form to excess. 

Have you ever used intoxicating liquors to excess f 

In addition to this, some companies ask the question : 
Have you used any so-called cure for the drinking or 
narcotic habit? If so^ which and loheii? 

After recording the answer, the examiner should criti- 
cally study the appearance of the individual; a moist, 
trembling tongue, flushed face, suffused eyes and uncer- 
tain, nervous movements, usually indicate free indulgence. 
Shifting occupation or place of employment, uaclean, 
neglected apartments and untidy appearance, help to 
confirm the impression. 

If a suspicion exists in the mind of the examiner, he 
should by all means, call attention to it. Be careful to 
state the kind of drink habitually used, and inquire, fur- 
ther, if any is taken before breakfast or in the morning. 
Remember that certain classes are especially prone to 
over-indulgence, — printers, hatters, plumbers, tailors, 
teamsters, moulders and those who are closely confined 
for long intervals and who work in ill- ventilated or over- 



LIFE INSUKANCE EXAMINATIONS. 19 

heated rooms, are apt to seek relief from the exhausting 
character of their work by the use of intoxicants. 

HABITS OF INTEMPERANCE. 

The question of habits in regard to temperance is one 
of the utmost importance in the selection of lives for 
assurance. The improvement in drinking habits among 
all classes of society which has taken place during the 
last quarter of a century has been very marked, and in 
the large majority of cases no kind of doubt will arise. 
But notwithstanding this, it is unhappily the case that 
although drinking to the extent of actual intoxication is 
comparatively rare, the habit of taking alcohol to an extent 
suflScient to seriously affect health and longevity is still 
sufficiently prevalent to make it necessary to watch care- 
fully for any indications of intemperance that may exist. 
On this subject it is useless to place any reliance on the 
mere statement of applicants. No man ever admits that 
he is intemperate, or even that he is careless or imprudent. 
A man who will readily answer any other questions as to 
his health with the greatest candor, will often become 
reticent or evasive when the question of temperance is 
approached. The examiner will of course readily recog- 
nize any of the usual physical indications of intemperance 
that may exist in the eyes, hands or tongue of the appli- 
cant, or in his general appearance. Even where marked 
indications of this kind are not present there may be some- 
thing in the general demeanor w^hich may give rise to 
suspicion, and anything of this kind, howevervague, should 
be noted on the report, so as to put the office on its guard. 
Even when the applicant states that he is a total abstainer, 
it is by no means conclusive. It may appear cynical to 



20 LIFE INSURANCE EXAMINATIONS. 

say so, but a statement of this kind is in itself sometimes 
suspicious. Of course there are now many people 
who can truly assert that they have never tasted intox- 
icants, and many more who have become total abstainers 
entirely from conscientious motives ; but, unfortunately, 
there are a great number whose present total abstinence 
has been adopted as a refuge from former intemperance, 
and which may be followed by relapse, in which the last 
state will be worse than the first. Inquiries should 
always be made with a view to ascertaining past as well 
as present habits. It is true that such inquiry is usually 
attended with difficulties, but the truth can in most cases 
be ascertained by careful and not too obtrusive questions 
as to the circumstances under which total abstinence was 
adopted. The experience derived from observation of 
many claims by death from diseases induced by intem- 
perance has convinced me of the truth of these remarks, 
some of the worst of such cases having occurred with 
persons who, when making their proposals, gave them- 
selves out as teetotalers. The statement was true at the 
time, and for the time ; but the total abstinence was of a 
temporary character, preceded and followed by excessive 
drinking. It is on this matter that the " private friends' 
reports *' are especially valuable. It is well known that 
every proposer for assurance is required to give the names 
of two friends who will answer a few questions as to their 
general knowledge of the applicant, especially as to their 
knowledge of past illness and as to past and present habits. 
Doubt has often been expressed as to the value of these 
reports. It is assumed that a man's friend will never be 
disposed to "give him away," to use a colloquial but 
very expressive phrase. To a great extent this is true ; 



LIFE INSURANCE EXAMINATIONS. 21 

but they will hardly ever say that a man is temperate if 
they know him to be otherwise. They will, however, 
frequently try to wrap up their statements in vague 
terms, which experience shows are sufficiently suspicious. 
The question as to habits is usually in the very direct 
form, "Is he sober and temperate?" It would be 
amusing, if it were not also rather pathetic, to note the 
answers frequently given to this simple question. * ' I have 
never seen him otherwise'' — "So far as I know" — 
" Not a teetotaler " — "A moderate man," are common 
forms of reply. My deliberate opinion is that unless the 
answer to this simple question is an equally simple 
"Yes," the applicant is usually, I will not go so far as 
to say always, a man who at least exceeds the limits of 
prudence, even if he does not go so far as to get habitually 
intoxicated. ■ — An English Authority. 

Alcohol. — State quantity and daily consumption, 
giving the form whether in malt liquors, wines or spirits. 
There is no means by which men beginning to give way 
to alcoholic excess can with certainty be detected by the 
examiner who sees the applicant for the first time. 

The shaking hand, the tremulous tongue, the story of 
the morning nausea are not always present. It is like- 
wise difficult to detect the opium eater or the chloral 
drinker, and these persons in the beginning of the abuse 
of these drugs may be passed by any examiner as healthy 
lives. However, when the odor of alcohol or any other 
drug is noted, the attention of the medical department 
should be called to it, so that the services of the inspection 
department may be called in to determine the habits of 
the man actually as contrasted with his declaration as to 
his habits. 



22 



LIFE INSURANCE EXAMINATIONS. 



A guide as to alcoholic habits has been often gained 
by the specific gravity of the urine. If the man is a 
water drinker, he does not drink water to a sufficient 
extent to reduce the specific gravity, if he is an alcoholic 
drinker he will probably have had some alcohol which 
may not be detected on the breath, but will be manifested 
by the urinometer. If a history of excessive use of in- 
toxicants is given, exact details should be stated — lolien 
the habit was formed, how long it was continued, the 
period of time which has elapsed since the habit was 
discontinued, the apparent effect upon the health, and 
the present limit of indulgence. 

Are you now using opium ^ morphine or other narcotics^ 
or have you ever used them ? 

The opium or narcotic habit is undesirable. These 
vices are often carried on secretly, and the examiner 
should be on his guard to discover the characteristic 
symptoms, as the contracted pupil in opium poisoning, 
etc. Incidentally, it may be mentioned that the use by 
the examiner of '' Tanret's " test for albumin will often 
disclose the use of morphine or other alkaloid by the 
applicant. 

(tanret's solution). 

Mercuric chloridi 1.35 grammes. 

Kali iodidi 3.32 '' 

Acetic acid 20.00 c. c. 

Aquae pur 64.00 c. c. 

To what extent do you use tobacco ? 

Tobacco, if used to an inordinate degree, has an un- 
favorable effect upon the nervous system and the heart. 
The drug seldom leaves an organic trace, but the func- 
tional effects are often very evident while they are present. 



LIFE INSURANCE EXAMINATIONS. 23 

This refers to tobacco in any form, including cigarettes, 
which often contain opium. The applicant should be 
postponed, especially if there is the so-called *' tobacco- 
heart," or if the nervous system has been unduly im- 
pressed. 

Has any proposal or application to insure your life 
ever been made to any company or agent upon which a 
policy has not been issued^ or is any now pending? If 
so, give full particulars. 

This question is one most prolific in producing corre- 
spondence with the Home Office, as by means of the so- 
called "Clearing House'' the medical directors have a 
list of all postponed and rejected cases since its institu- 
tion. Having the names and other means of identifica- 
tion, they readily obtain the full particulars of the original 
examination upon which a rejection or postponement was 
based, and it is often amusing to observe the antics of 
the prevaricating applicant when he is confronted with 
the details of his early refusal by a company. 

Upon being asked why he denied the rejection, the 
applicant frequently answers that he didn't deny it, that 
he *'was never asked the question,*' that he ''didn't 
know he was rejected," that he was told he was accepted, 
but refused to take the policy, etc. , etc. 

To guard against all the possibilities of such a case, it 
is good practice to ask the applicant a few preliminary 
questions, such as, have you ever been examined for life 
insurance? and upon his affirmative reply, ask if the 
companies all issued policies. This will call his attention 
to the pointed question on the blank, and if he denies a 
rejection then^ he will be condemned out of his own 
mouth. The writer has known applicants to give the 



24 LIFE INSURANCE EXAMINATIONS. 

names of companies which were said to have issued 
policies, whereas the record shows rejection by these 
same companies. 

Has any medical examiner ever given an unfavorable 
opinion in regard to the insurableness of your life? 

This is used to meet those cases where '^ trial exami- 
nations " are sometimes made by an examiner, at the re- 
quest of an agent, but, as the applicant's signature is not 
obtained, no official record is made. The intelligent ap- 
plicant, however, receives some practical instructions by 
means of which he may be presented in a more favorable 
light in a subsequent examination for another company. 

To meet all the indications of this situation, the fol- 
lowing question occurs on the form of one company — 
^^ Has any physician ever given you an unfavorable 
opinion upon your life with reference to life insurance^ 
formally or informally^ with or without you making an 
application?^^ If so, state particulars. 

Family History. — Every medical man who has kept a 
record of his cases or who has examined the literature of 
the subject has undoubtedly been struck with the fact 
that a certain tendency to diseases which has manifested 
itself in the ancestry of his patients has also shown itself 
either as to the identical maladies or those germane to 
them in the patients themselves. This fact has become 
so noticeable that every scientific practitioner makes in- 
quiry as to the diseases of which the immediate, as well 
as the collateral relatives have died, and according to 
the nearness of these relations and their numbers, so will 
be the probable intensity of the influence upon the in- 
dividual. 

If the patient is afflicted with an affection of the throat, 



LIFE INSURANCE EXAMINATIONS. 25 

lungs or chest, and some of his relatives have died of 
diseases situated in either of these localities, suspicion is 
at once aroused that the patient may also have a similar 
affection in a latent state, and especially if the physical 
signs point that way, and the treatment is directed 
accordingly. 

This principle is utilized in the business of insurance. 
Thus, although the party is supposed to be in health, else 
he would not be presented for examination, if his relatives 
have died of constitutional diseases, these diseases are 
given a certain value, and according to the nearness of 
kinship to the applicant and the number of instances in 
the family as above stated, so will be their influence upon 
the insurability of the applicant, and the life by so much 
will be impaired. Of course the age, personal history, 
occupation and environment of the individual must also 
be considered. The family history of the applicant is 
a very important factor therefore, and being so, it is 
desirable that the examiner shall record it carefully, get- 
ting from the applicant or other reliable sources all in- 
formation upon this point possible, filling up every part 
of the blanks even the duration of the illness, which is so 
universally disregarded. It is well known, also, that 
certain families die at or about certain ages from causes 
other than constitutional. This is the vulnerable period 
in his family history as well as in himself. There may 
be in individuals as well as in families, therefore, a want 
of vitality, and such families and individuals are desig- 
nated as '' short lived." This has its value in the style 
of insurance which the company is willing to write. 

If any member of the family is not well, or is delicate, 
state specifically, as near^as possible, the nature of such 



26 I.IFE INSURANCE EXAMINATIONS. 

sickness ; its cause, duration, and the present condition 
of such naember. 

If the parents of the applicant are blood relations, 
this fact should be stated, and if any characteristic effects 
are noticeable, state particulars. 

In recording the causes of death, vague and unmeaning 
terms should not he used, such as '''•general debility^'' 
^'•childbirth,'' '-''exposure,'' '''' female diseases," ''''compli- 
cation of diseases," and the like. Such terms convey no 
particular information to the home office and are apt to 
be, and often are, construed to mean a condition more 
grave than the real facts of the case would warrant. Ex- 
aminers are requested to analyze the statements which 
the applicants make, and state specifically, as nearly as 
possible, the cause of death. In case of accident, state 
whether death was immediate or lingering, and the cause 
of the protracted illness. In case of confinement, state 
previous health, duration and other particulars when 
necessary, or whether such member of the family died in 
labor. A ''complication of diseases " necessarily carries 
with it the idea of a protracted illness, with a numerous 
train of consecutive attacks, hence a suspicion of con- 
sumption, especially since such a large percentage of the 
human race die of this disease. Please be specific, if 
possible, and state the duration of diseases, as welLas all 
other obtainable or necessary details. It should also be 
remembered that constitutional diseases often show them- 
selves in the second generation. Please, therefore, be 
particular to record the causes of death, as nearly as pos- 
sible, of the grandparents, as well as their ages at death. 

The blank should be filled up by the examiner. 

In ascertaining the family history, care should be ex- 



LIFE INSURANCE EXAMINATIONS. 27 

ercised to get at the facts. Applicants sometimes wish 
to deceive as to the causes of death of certain members 
of the immediate family. Do not accept ' don't know ' 
as a cause of death, unless you absolutely fail to elicit any 
information whatever. There are cases when an applicant 
cannot state the exact cause of death of some member of 
his immediate family, but where the examiner can obtain 
a more or less complete history of the last illness, which 
will eliminate any hereditary tendency or prove the con- 
trary. If inquiry has been made aud nothing ascertained, 
enter in the space devoted to remarks that such is the 
case. — Manhattan Life Instructions, 

Have any of your near relatives (including uncles and 
aunts) now or ever had consumption^ cancer^ apoplexy^ 
or other hereditary disease! 

If an applicant is under 30 years of age, and it is 
discovered that one of his parents died of consumption, 
this being the only death in the immediate family, it 
should be the aim of the examiner to find out if that 
parent's history is clear of a tuberculous taint. If it is 
the applicant's father, he should inquire regarding the 
causes of death and the ages at death of the paternal 
grandparents, uncles and aunts ; if^ the mother, the inquiry 
should be directed to the maternal grandparents, uncles 
and aunts. 

Relating to consumption, special questions should be 
fitted to the occasion to elicit the details as to the envi- 
ronment and tuberculous relatioijs. One company asks 
if the applicant has lived in a house or room occupied 
by a consumptive within the past three years, and another 
company wants to know if the applicant's wife (or hus- 
band, as the case may be) is a consumptive or in a low 



28 LIFE INSURANCE EXAMINATIONS. 

condition of health. In the event of a consumptive his- 
tory, the condition of the lymphatic system should be 
noted. If a history of apoplexy, the build and tendency 
of the applicant should be observed. 

Which parent do you most resemble in appearance and 
constitution f 

This is a natural appendix to the previous question, 
and any reference which might be suggested by the re- 
semblance will be in order for submission. 

Have you ever had, or been predisposed to, any of 
the foUoiving diseases or infirmities? 

If so, state the full particulars, giving dates, severity, 
duration, nature and number of attacks. 

Some companies require a separate yes or no to each 
ailment, while others use groups and brackets, calling 
for a separate answer to each. 

Apoplexy. — In the event of an affirmative answer, it 
will be necessary to comply strictly with the directions 
above, and in addition inquire as to the disease of the 
vessels; cardiac hypertrophy, Bright's disease, syphilis, 
gout, and especially hereditary tendency, giving a good 
description of the applicant, so that the Medical Director 
may have a picture of the case before him. Aim to locate 
the cause of the attack. 

Asthma. — If yes is answered give the details, and in 
addition examine for any possible sequel, such as emphy- 
sema, cardiac dilatation, dropsy, and supply information 
as to complications, as^ for instance, chronic bronchitis, 
rheumatism, and valvular disease of the heart. State 
whether the applicant presents the appearance of a neu- 
rotic. Give the treatment employed for relief, as many 
cases are self-treated, and the nonchalant manner in which 



LIFE INSURANCE EXAMINATIONS. 29 

asthmatics use chloroform, and other drugs thought to 
be dangerous, is surprising. * * * As bronchial 
asthma often runs in families, it would be desirable to 
draw forth any further information bearing on this ten- 
dency. Inquire as to any associated trouble, such as 
throat and nose affections, and among which may be men- 
tioned enlarged tonsils, chronic catarrh, nasal polypi. 
State particulars regarding so-called rose asthma and hay 
asthma, and mention whether applicant has attacks of 
orthopnoea. 

Bronchitis. — This calls for a searching examination of 
the chest, which should be thorough, to establish the fact 
that complete resolution has taken place, if the attack 
was acute, or to indicate the opposite if a chronic bron- 
chitis supervened. 

In cases of chronic bronchitis information will be in 
order as to any irritation which may keep it alive, and 
search should be made to exclude or locate the affections 
of which it is a frequent attendant, such as tuberculosis, 
cardiac valvular disease, especially mitral disease. Also 
Bright's disease. 

Cancer or Tumor. — Of course no applicant will admit 
having cancer, nor present himself for examination if the 
condition is discoverable by meaas of clinical diagnosis. 
However, they will often admit having ''tumors," so 
that the companies are then protected by means of dif- 
ferential diagnosis. The wnter once had an applicant 
tell him that he "• had a swelling on his tit.'' Investiga- 
tion disclosed what was assumed to be a lipoma over the 
mammary region, and while the applicant was postponed, 
as a precautionary measure, until after its removal, yet 
he has since obtained additional insurance, based upon 



30 LIFE INSURANCE EXAMINATIONS. 

this diagnosis, which was established by its removal, and 
the prompt healing of the wound. 

The hereditary tendency to cancer receives close scru- 
tiny in deciding upon a risk, and women are looked upon 
with suspicion, in view of the difficulties attendant upon 
their examination for life insurance. Habitual smokers 
should be scanned closely as to the buccal conditions, as 
the companies have a large mortality score marked up 
against them. 

The prevalence of hepatic cancer has induced some 
companies to insert a special question in their new form 
for examination, as follows: " Is the hepatic area sensi- 
tive on percussion, or enlarged or diminished in sizeV^ 
The association of a cancerous and tuberculous family 
history in an applicant past forty years, gives rise to 
much concern in the minds of some Medical Directors, 
and rightly so, too, if a selection is to be made on the 
basis of medical science and experience. 

Every tumor should be described in detail, giving its 
appearance, size, location, time of appearance, appli- 
cant's view as to the cause, also to what structures it is 
attached. The exhibition of one tumor, however small, 
should call for an examination as complete as that made 
on an applicant for admission to the army or navy, in 
order to exclude or disclose other tumors. 

In the event that a tumor of any kind has been removed, 
it is desirable to know if a microscopic examination was 
made and its benign character assured. Also, are the 
lymphatic glands enlarged? Has any of them ever been 
so? Is the cicatrix resulting from the operation now 
in a healthy and normal condition. 

Colic. — In view of its common occurrence, an appli- 



LIFE INSURANCE EXAMINATIONS. 31 

cant otherwise reserved in his statements will often ad- 
mit having had a colic. In this connection no pains 
should be spared in supplying the essential facts relating 
thereto, for the benefit of the Medical Director. 

If the colic is admitted to be, or seems to be, hepatic, 
make inquiries as to the passage or symptoms of gall- 
stones, which are common in very fat people and in 
women, and are often associated with carcinoma of the 
liver and stomach. If jaundice is present, or has been 
present, test the urine for bile, and if the bile reaction is 
evident in the use of the nitric acid contact test, make 
suitable investigation to show the condition of the liver. 
If an operation for gall-stones has been performed, advise 
as to the nature of this operation, whether simply the re- 
moval of a gall-stone from the duct, or whether stones were 
removed entirely from the gall-bladder. In cases of in- 
testinal colic, it is well to bear in mind the causes, which 
may be summarized as follows: constipation, lead- 
poison, syphilis, chronic malaria and rheumatism. Get a 
full description of the painful area. In lead colic look 
for the symptoms of slate-colored skin, dark gums show- 
ing a blue line, heavy breath with sweetish metallic odor, 
obstinate constipation, slow pulse and contracted abdom- 
inal walls. , 

In nephritic colic the pain follows the course of one or 
both ureters, shooting to the loins and thighs, with re- 
traction of the testicle of the affected side, stranguary 
and bloody urine. 

In uterine colic the pain is in the pelvis, and associated 
with menstrual disorders, of which a statement should be 
obtained from the attending physician. 

In ovarian colic neuralgic pain is present over the 



32 LIFE INSURANCE EXAMINATIONS. 

ovaries, with hysterical phenomena. No matter what 
kind of colic should be apprehended, it is safe to suspect 
and investigate as to a probable narcotic habit associated 
with or following it. 

Coughs (PROLONaED). — An applicant will occasionally 
be candid enough to say that he has a cough in winter, 
but that it don't amount to much. To clear up any 
speculation on the subject, the same care should be 
exercised as in a case of chronic bronchitis. The element 
of hoarseness should be looked into, and if present a 
close examination of the throat should be made, and the 
cause of the hoarseness ascertained, so that a correct 
estimate may be made as to its gravity. The possibility 
of its relation to syphilis should not be overlooked, and 
in proceeding to the throat examination it will be in order 
to observe in passing the condition of the buccal cavity, 
and to draw deduction from any lesion which may be 
active or remain as a sequel to former disease. 

Report if he is subject to cough, expectoration, pal- 
pitation or dijfflculty in breathing. 

Diseases of the Ear. — An authority from Chicago 
gives the following list as indicating an unfavorable 
prognosis, and hence a bar to life insurance: — 

(1) Erysipelas of the auricle and meatus; (2) phleg- 
mon, gangrene and ulcer of the auricle and meatus ; (3) 
subperiosteal abscess ; (4) perforation of the membrana 
tensa in the post-superior quadrant; (6) bulging post- 
superior wall of meatus; (7) cholesteatoma of the mid- 
dle ear, attic, antrum or mastoid cells; (8) chronic sup- 
puration with a recurrent pain over the mastoid; (9) 
chronic suppuration with polypi and granulation of the 
middle ear; (10) chronic suppuration with small perfo- 



LIFE INSURANCE EXAMINATIONS. 33 

ration in the membrana tensa; (11) chronic suppuration 
with necrosis of the ossicles ; (12) chronic suppuration 
with necrosis of the tympanic walls; (13) chronic sup- 
puration with the membrana tympanum entirely gone 
and the ossicles buried in a mass of fibrous and granu- 
lation tissue at the floor of the attic; (14) pinhole per- 
foration at the margin of the drum-head; (15) malig- 
nant disease of any part of the ear; (16) tubercular dis- 
ease of the ear; (17) narrow external meatus following 
chronic suppuration; (18) sclerosis attended by marked 
deafness; (19) neoplasms of the middle ear; (20) hy- 
peremia of the labyrinth attended by a rapid pulse may 
indicate tuberculosis, heart or kidney disease, and should 
be looked upon with suspicion; (21) hemorrhage into 
the labyrinth indicates caries of the petrous portion of 
the temporal bone, kidney or heart disease; (22) all 
/pronounced labyrinthine inflammations, whether they are 
from extension of the middle ear disease or from infec- 
tion arising during the course of the exanthematous 
ferers or from syphilis, should be barred ; (23) inflamma- 
tions and impairments of the auditory nerve from menin- 
gitis, cerebro-spinal meningitis, syphilis or brain tumors. 

Discharge from the Ear. -—Any defect of hearing 
should lead to inquiry for a history of otorrhoea. If such 
exists, or has existed, full particulars should be given. 
The date of its occurrence, the cause, the length of time 
continued, whether purulent, bloody or offensive, and 
whether periodic or continuous, should be ascertained and 
noted. 

Examine carefully the local conditions and report your 
finding. Most companies will not issue upon an appli- 
cant who has had an aural discharge unless five years 

8 



34 LIFE INSURANCE EXAMINATIONS. 

has elapsed since its cessation, and the testimony of the 
physician who treated it is invoked to fix the date, and 
the exact diagnosis, etc. 

Disease of the Brain. — This has a wide range, '* from 
rush of blood to the head" to apoplexy, and while it is 
a rare thing for an applicant to admit that he has had a 
brain disorder, yet such rare cases call for extra care in 
presenting the true facts in the case. As a guide to help 
along the way, some companies ask an additional question, 
viz. : Have you ever been under treatment in any asylum 
cure or sanitarium^ If so^ when^ how long^ and for 
what? 

Having learned the symptoms, endeavor to locate the 
cause. 

The causes of "congestion of the brain'* may be 
given as follows: ''Increased cardiac action, the result 
of hypertrophy of the left ventricle ; general plethora, 
excesses in eat'ng and drinking; alcoholism, sunstroke, 
prolonged mental labor, diminished amount of arterial 
blood in other parts, the result of compression of the 
abdominal aorta, the ligation of a large artery, dilatation 
of the right heart, pressure upon the veins returning the 
cerebral blood. Injuries to the head, syphilis and gout 
should be borne in mind as causes of brain trouble, and 
should be investigated accordingly. 

Disease of the Heart. — When a history of heart 
disease is given, inquiry should extend over its various 
parts, such as the pericardium, endocardium, the heart- 
muscle, the cavities and the valves. 

Pericarditis and endocarditis may be secondary to 
rheumatism, pneumonia, pleurisy, erysipelas, Bright's 
disease or pyemia. 



LIFE INSURANCE EXAMINATIONS. 35 

Myocarditis may be incident to endocardial or peri- 
cardial trouble, or to pyemia, typhoid fever, or emboli 
of the coronary arteries. 

Dilatation of the heart may be caused by over-exertion, 
insufficiency of the valves, emphysema, chronic bron- 
chitis, gout, Brigbt*s disease. 

Valvular lesions occur as a sequel to endocarditis, and 
have been traced to overworli and strain of the heart in 
early life. Other causes are syphilis, dilatation of the 
heart, atrophy or contraction of the heart, congenital 
malformation. If the examination develops any ab- 
, normality, describe it and fortify your judgment by every 
possible means. State the exact part of the heart which 
you find to be affected, and if the trouble is valvular, 
mention whether it is systolic or diastolic, and also state 
the position of the apex beat and its character. Test the 
effect of vigorous exertion by causing the applicant to 
practice some gymnastic exercise, such as walking up 
and down stains, or hopping on one foot around the 
room. Mention if he has dyspnoea, palpitation, 
dropsy or other symptoms. Dr. E igar HoMen, of the 
Mutual Benefit Life, speaking of cardiac lesions follow- 
ing rheumatism, says of the eligibility of individuals 
for life insurance, using the term in a broad, general 
sense, without reference to insurance for definite term : 
''Perhaps we will do well in considering the subject, 
to reduce the question to simple terms, viz., How far 
should the cardiac lesion following rheumatism affect the 
eligibility of applicant'^ for life insurance, either for the 
full term or for a definite and limited number of years? 
There can be no question that large numbers whose 
hearts have been impaired in a greater or less degree by 



36 LIFE INSURANCE EXAMINATIONS. 

rheumatism continue to live and enjoy a good decree of 
health for many years. Now, it is not a difficult matter 
to estimate any man*s chances of living for a few months 
or a few years, or even for ten or twenty years, but if we 
ask ourselves the question, 'Would a large number of 
such cases furnish a mortality below the tables?' We could 
hardly fail to say, ' No.' If, however, with certain heart 
lesions which nature has balanced by compensating 
changes, we are to weigh the chances of living for ten 
years we have before us an entirely different question. 
But the risk then becomes properly a sub-standard one, 
and there is another and grave element of doubt grow- 
ing out of the fact that the diagnosis has been made by 
physicians whose actual knowledge of heart troubles we 
do not know. If we could see and examine ourselves 
all cases where heart lesion is suspected, we could with 
reasonable safety decide what amount and for what term 
insurance could be granted. I think, however, that con- 
sideration of applicants who have actual impairment of 
the heart involves extra hazard, and that for ordinary 
rates they should not be entertained." 

Diseases of the Lungs. — The catechism under this 
heading should be thorough and should extend to the 
various affections to which the lungs are subject. This 
thoroughness is necessary, not only as an aid to the esti- 
mate of the risk by ihe medical director, but also as a 
guide to the physical examination by the examiner, so 
that all obscurities may be cleared up. It is diffl mlt, 
under the most favorable conditions of examination, to 
locate slight lesions of the lung, but when one his a 
guide such as the correct diagnosis of previous lung 
trouble, the investigation becomes more satisfactory as to 



LIFE INSURANCE EXAMINATIONS. 37 

accuracy in the pre^sent coi2<iitioa. AppMcants will often 
say that they had some lung trouble previously, but 
cUira n 't to know the name w ach was given to it. If 
asked if it was pneumonia, they will say no, but if the 
various synonyms of pneum >nia are mentioned to them, 
they may recognize it under the name of congestion of 
the lungs, lung fever or winter fever, or capillary bron- 
chitis, and upon further questioning thev may go so far 
as to indicate the point at which the trouble was for- 
merly located by the physician. It is needless to add 
that in this event or iu the event of any suspected pul- 
monarv trouble, the applicant should be strip[)ed and 
the lungs completely gone over by all the means known 
to physical diagnosis. The subject: should not be dis- 
missed until the examiner feels absolutely certain of him- 
self and his finding. Piuerisy is regarded by the laity 
as an ailm^^nt of slight import in its relation to mortality, 
and it will be sometimes admitted as a'' stitch in the side." 
The relation between a former pleurisy and a subsequent 
phthisis has been traced in so many cases that the 
selection for insurance becomes concerned about it, 
unless every possible remaining feature may be excluded 
by examination. In the event that effusion has taken 
place, the case becomes the morb grave from this point 
of view, and if aspiration or operation has been invoked 
to relieve the latter condition, it usually operates as a 
bar to any kind of in-^urance except sub standard. The 
apprehension of phthisis following as a sequel to a pleurisy 
seems to be gaining in the minds of medical directors, 
no doubt as a result of exp^^rience based npon c'aims paid. 
Diseases of the Throat. — An admission of throat 
trouble takes with it the necessity of a local examination 



38 LIFE INSURANCE EXAMINATIONS. 

of the parts, to indicate their present condition. The re- 
lation of the symptoms and circumstances attending the 
original attacks will help mated illy in clearing the way 
to a reliable conclusion as to cause and effect. One of 
the cmses which should always he investigated is syphilis, 
and a description should be given of any lesion, active 
or as a sequel, to indicate this disease, which gives the 
medical director so much concern. In this connection 
chronic hoarseness should always be viewed with sus- 
picion, both on account of its bearing on syphilis, as well 
as on tuberculosis. 

Diseases of the Throat and Nose. — Attention will 
be frequently attracted by nasil obstruction. Usually 
this will be caused by hypertrophic rhiniiis or septal de- 
formity, but a closer examination may reveal the exist- 
ence of a nasal polypi, retro-nasal fibro-mucus polypi and 
malignant tu'nors. 

Asthma is found commonly associated with and aggra- 
vated by nasil polvpi, hav asthma is viewed with concern 
on account of its known liability to end in a chronic bron- 
chitis. A symptom of nasal discharge which is frequently 
obtained upon the examination is fetor, and it is usually 
an accompan»ment of ozena as well as the necrotic 
state of nasal syphilis. The saddle-back nose and perfo- 
ration of the cartilaginous septum should call for further 
inquiry into a possible syphilitic cause. 

The mouth, tongue and pharynx should be investigated 
for syphilitic lesions, mu(^us patches and superfieial ulcers, 
whether of the early or late type. Cnronic hoarseness 
mav pnint to laryngeal tuberculosis or t > svf>h lis, the fir^t 
being marked by a soft, weak voice with an accompani- 
ment of aphonia, and the hoar&eness of tertiary syphilis. 



LIFE INSURANCE EXAMINATIONS. 39 

beinof indicaterl by a low hoarseness which is rougher and 
accompanied by pain or swelling. Impairment of the 
voice should call for particulars as to ils cause, onsets, 
duration and disposition to recurrence. 

Obesity. — Sufferers from too redundant fat have from 
time immemorial been recognized by medical authorities 
and other observant people as being peculiarly unfitted 
to resist onsets of acute diseases, as apt to be short lived 
and as being liable to sudden death, they are likely to 
die of those degenerations of arteries, muscles and inter- 
nal organs which we know are dangerous, threatening the 
life of the fat man. Speaking generally, a man under 
fifty years of age should never have the girth at his navel 
greater than the empty chest. An English authority 
says: *' If he has a larger girih around his navel when he 
is under fifty, I 1 )ok upon it as referring to a one or the 
other of three ' ins * — indolence, indulgence, or intem- 
perance, or perhaps all three." 

Disorders of the Liver. — These are regarded with 
as litile concern by the applicant, as they are regarded 
with great concern by the medical insurance authorities 
who are to pa«s on his application. An admission of 
occasional *' biliousness" or torpid liver may prove, on 
close investigation, to be something more grave. As a 
point in clinical diagnosis, it is a good practice to observe 
all the reactions in the U'^e of the contact test with nitric 
acid. While making the uranalysis, after observing the 
reaction which indicates or excludes albumin, let the test- 
tube stand for a few minutes, when the characteristic 
play of colors may also point to bile or the bile acids, in 
which event it will be in order to interrogate the hepatic 
region more nearly than ordinarily. 



40 LIFE INSURANCE EXAMINATIONS. 

Jaundice should always call forth special inquiry, and 
whether the examiner believes it to be of slight importer 
not, it should be repr)rted for the benefit of the medical 
director. Its appearance in a drinking man should pro- 
voke a diligent search for additional dropsy, enlarojement 
of the superficial abdominal veins, muddy skin, and the 
distended abdomen with thin legs, which is characteristic 
of sclerosis of the liver. Syphilis should always be in 
mind as a cause of hepatic sclerosis, and the usual tests 
should be made to exclude it, before recommending the 
risk. Jaundice is the main objective guide to the diseases 
of the biliary passages. 

Diseases of the Bladder. — If this condition happens 
to be active, the way should be clear to a correct diag- 
nosis through the uranalysis, and if the chemical uranaly- 
sis is not deemed to be entirely conclusive, the microscope 
should clear up any doubt in the case. Applicants will 
often admit having been troubled with cystitis following 
gonorrhoea, and will claim that both have been cured. 
This affords a rare opportunity for the exercise of the 
diagnostic acumen of the examiner, and the case should 
be probed to the bottom, as otherwise a subsequent ex- 
amination and rejection by another company may throw 
discredit upon a careless examiner. The improved 
methods of clinical diagnosis now throw so much light 
on this subject that all obscurity should be cleared up in 
every case. The examiner should avail himself of all the 
information which he can obtain from the applicant as to 
the symptoms, the original diagnosis and the treatment 
of the case of which he gives the history. 

Diseases of the Kidneys. — While a scientific uranaly- 
sis should furnish us a fair index as to the soundness of the 



LIFE INSURANCE EXAMINATIONS. 41 

kidney, it would be advisable to probe all the subjective 
relations wliicb an applicant naay communicate as to pre- 
vious disease, supposed to be nephritic in character. 

For this purpose he should be asked as to pain, the 
location and character of which should be described. 
Learn if it follows the line of the ureters to the groin ; if 
there is any pain produced in the testicle or head of the 
penis ; or if it extends partially around the body. In- 
quire as to hematuria, and ask if the applicant remembers 
anything in the physical character of the urine which was 
thought to be abnormal. The laity recognize '* porter- 
colored " urine as abnormal. Get information as to 
whether the attack was accompanied by nausea and 
vomiting, and if headache was present. Ascertain the 
applicant's recollection as to the quantity of urine, whether 
he deemed it scanty or excessive. Among the causes of 
hematuria it is well to recall renat calculus, and if the in- 
dications call for a microscopic examination the centrifuge 
should also be used, and if blood ceils are found in the 
sample of freshly voided urine, which coiitains crystals, 
it will be a st^p toward certainty in the matter of diagnosis. 
Presumably gouiy persons should be held under suspicion 
in this connection. Among the very serious causes of 
hematuria, tuberculosis, tumors ,and cancer stand out 
prominently. 

Malaria must not be forgotten as a promoting cause 
of blood in the urine. Syphilis is also given as an occa- 
sional cause of this symptom. 

Anemia and dropsy should receive due attention as 
concomitants of nepliritis. Frequency of micturition 
and rising at night to void urine may elicit some corrobo- 
rative points. 



42 LIFE INSURANCE EXAMINATIONS. 

The '* kidney expression'' is described as a peculiar 
cachexia showing a puffy, doughy appearance, character- 
istic of this trouble. The condition of the vessels as to 
atheroma, and that of the pulse as to hardness and high 
tension should be noted. 

Cardiac hypertrophy and accentuation of the second 
aortic sound call for notice. 

Dizziness or Vertigo. — This symptom being a concomi- 
tant of various diseases, should call for a clo^e investiga- 
tion as to ihe cause, in order to he able to make a proper 
estimate as to its gravity. Among the vertigoes traceable 
to affections of the special senses, ocular vertigo stands 
out prominently, being caused by eye strain or astigma- 
tism. Meniere's disease, or aural vertig^o, is of frequent 
occurrence, and is associated with marked tinnitus aurium, 
and the veitiirenous sensations are further described as a 
see saw motion, a gyratory motion, right or left; a verti- 
cal whirl, or a sensation of rising and falling, like the 
swell of the ocean. 

Gastric vertigo being the most common variety of all, 
should elicit particulars as to stomachic or intestinal dys- 
pef)sia, di>ordered hepatic function and eonsti[)ation. 

Nervous vertigo is found in tho^^e addicted to physical 
or nervous excesses, as well as being due to the immod- 
erate use of tea, coffee, alcohol and tobacco. In solving 
any case, the possible existence of organic cerebral dis- 
ea*^emust be kept in mind As one of the manifestations 
of the so called "aura epileptica," it must call forth 
unusual care. The writer has in mind the case of an ap- 
plicant whose neighbors were well aware of his epileptic 
attacks, yet he elu<iefi inquiry by several examiners, and 
received a large amount of ijisurance, which has since 



LIFE INSURANCE EXAMINATIONS. 43 

been paid. As an indication of uremic intoxication, and a 
symptom of Britjht's disease, it is expected that a scientific 
uranalj^sis should guard ihe interests of the companies. 

Vertigo is often found in gouty subjects, after a lapse 
from the dietetic regime which is necessary to keep them 
from one of their usual par()X\sms. 

Drofsy. — General dropsy, affecting the subcutaneous 
tissue, the peritoneal cavity, and the internal serous cavi- 
ties and organs generally, is usually the result of albumin- 
uria, and most frequently of that form which depends on 
fatty degeneration of the ki<lney. The next most frequent 
cause of dropsy is tricuspid regurgitation, obstructing the 
venous circulation throughout the body. Ihis regurgita- 
tion generally depends on dilatation of the right ventiicle, 
consequent upon obstruction to the flow of blood through 
the lungs, either from chronic bronchitis and emphysema 
or mitral obstruction and regurgitation. Dro[)sy from 
cardiac dis» ase generally appears first in the feet, if the 
patient has been for some time in an uprigiit position, 
while dropsy from albuminuria is often first remarked by 
a puflSness in the eyelids. In the former it appt^ars where 
the greatest obstruction to reabsorption takes place, and 
in the latter case in those pans where loos-eness of the 
cellular tissue most readily allows of exudation. 

Local dropsies have as a rule local causes, as in hydro- 
cele and pleuritic effusion. If the dropsy is supposed to 
be of cardiac origin, it is in order to ask as to other symp- 
toms, such as dyspnoei and palpitation, and also locate 
the position and describe the character of the apex- beat. 
Ascertain if con pen-ation is perfect, and discover the 
rate and character of the pulse after vigorous exercise. 
Jf there is suspicion of an albuminuric condition, inquire^ 



44 LIFE INSURANCE EXAMINATIONS. 

if he suffers from lassitude, sleeplessness, headaches, 
vertigo, dyspnoea, gastric disturbances or alteration of 
vision. Try to obtain or exclude hist'»ry of etlema of 
the feet or puffir}ess of the eyelids. Ob>erve if his ap- 
pearance shows anemia or pasty complexion. Examine 
the pulse as to hardness or high tension, and look for 
signs of atheroma of the vessels. Interrogate the heart as 
to hypertrophy and acceutuation of the second aortic 
sound. Ask if he has noticed increase or diminution in 
quantity and frequency of micturition, and also if he 
arises at nio^ht to void urine, and hf)W often. 

Diarrhoea (Habitual). — It is not often that an appli- 
cant will admit habitual diarrhoea and at the same time 
seek life insurance, but such rare cases are interesting, 
and a thorough investigation becomes valuable as a 
matter of statistics bearing on future examinations of the 
same applicant, when he mny not be so candid. An ap- 
plicant will often be drawn into an admission of this 
character, as a side-light to his answer as to being a 
pensioner, which information some compan es call for. 
He will then try to qualify his answer by attempting to 
minimize its bearing upon the question at issue, viz., the 
issuance of a policy. In this connection it is well to re- 
call to mind the various morbid states of which diarrhoea 
is symptomatic, and the following may be mentioned as 
indicating its gravity from a life insurance point of view. 
F. r instance, in '' passive congestion of the portal vein," 
from disease of the liver, heart or lungs, organic disease 
of the intestines — ulceration (simple, typhoid, tubercu- 
lar, cancerous), lardaceous degeneration, enteritis, dys- 
entt-ry, malaria, gout, Bright's disease (later stages), 
phthisis, cancer. 



LIFE INSURANCE EXAMINATIONS. 45 

Dyspepsia. — The function of digestion being of a 
physico-chemical nature, any interference with tUe due 
performance of the several components of the function 
will lead to indigestion, and may become of a complex 
nature. Disturbances of the functions will make them- 
selves felt in the one under consideration. Dyspepsia 
may be traced to (1) the food, (2) disturbance of the 
so-called mechanical process, (3) imperfection in the 
chemical changes exercised by the digesiive secre- 
tion. These considerations present an extensive scope 
for exposure to health impairment, and should invite 
close scrutiny to discover the gravity of the case in 
hand. 

In the investigation the state of the tongue, its color, 
size, and general appearance as to fur, dryness, smooth- 
ness, and prominence of papillae, are often indicative of 
the condition of the stomach and intestines. Such sym- 
pathetic symptoms as headache, pain in the back or in 
the right shoulder, dizziness, specks in the field of 
vision, palpitation or irregular aciion of the heart, 
cough, disordered urine, etc., indicate the relation exist- 
ing between the digestive organs and the body generally. 
The more general symptoms that are found with disor- 
dered digestion, may be those of pyrexia, when an acute 
inflammatory condition of the digestive organs is the 
cause of the disturbance. The forms of many companies 
now require the temperature undtr the tongue to be taken 
and recorded. 

General Debility. — Strange as it may seem, appli- 
cants have presente i themselves for life insurance while 
in a state of general debility, and while tbey are disposed 
of with ease and grace, the cases which give a history of 



46 LIFE INSURANCE EXAMINATIONS. 

previous so-called general debility are the ones which 
will call forth more protracted inquiry. 

Debility is most commonly due to impaired nutrition, 
whether this be prolonged and moderate, as in defective 
hygiene or chronic illness, or, on the other hand, rapid 
and extreme, as in acute disease. Another frequent 
cause is abuse of the affected organ. Over use of any 
part leads to fatigue, and if frequently repeated to ex- 
haustion, the chief feature of which is extreme debility, 
as in cases of sustained exertion, or repeated strain of 
the heart. "Work and worry" are frequent factors in 
the production of debility. Debility due to acute dis- 
ease may, in the absence of complications, be expected 
to disappear during convalescence. If the bause has 
been more chronic, and is less easily removed, recovery 
will certainly be more slow and less satisfactory. The 
above considerations should be a guide also in cases of 
reputed "nerve prostration." 

Fits. — Unconsciousness or convulsions of any sort. 

In probing a history of this kind, the age of the appli- 
cant at the time of onset should first be considered. The 
ordinary spasms or convulsions of infancy do not often 
leave such a sequel as to present a serious obstacle to life 
insurance, when the insurable age is reached. 

Adolescence, excessive study and mental application, 
as well as worry and anxiety, must be enumerated among 
the causes of epilepsy and convulsions. At all ages trauma- 
tism will suggest itself as an etiological factor to be investi- 
gated mo^t carefully as to past and remaining conditions. 

In early adult life, syphilitic indurations or growths 
from the meninges may occur. 

In the female, puerperal convulsions^ and uremia. 



LIFE INSURANCE EXAMINATIONS. 47 

Convulsions in both sexes are most frequently met with 
between 20 and 40. 

Intemperate habits, carried to excess, often produce 
fits, and so also may venereal excesses. 

Exposure to great heat, or sunstroke, may act as the 
exciting cause of convulsions. 

In the period after middle age, toxemia from renal 
disease may manifest itself in this connection. 

Fistula. — Any fistula in existence at the time of ex- 
amination is an effective bar to the issuance of a policy 
upon the bearer of the fistula. As a rule the applicant 
is postponed until the trouble is radically cured. A his- 
tory of fistula treated previous to the examination neces- 
sitates a careful local examination, the details of which 
should be reported, giving the exact condition at the time. 
In the diagnosis of so-calltd fistula it is well to recognize 
that all perineal fistu'ae in the neighborhood of the anus 
are not necessarily connected with the anus. They may 
be due to stricture of the rectum, or to necrosis of the 
sacrum or coccyx, or to stricture of the urethra, or to 
disease of the prostate gland. The his'ory of the case, 
the direction of the sinus, and examination of the sur- 
rounding parts, will sufficiently distinguish these from an 
anal fistula. In chronic cases the perineal opening is 
usually marked by projecting granulations, but in recent 
cases this indication does not exist, and the examiner 
may have to search closely for the orifice, if it be small 
and concealed by folds of skin round the anus. In cases 
wnere the discharge has ceased, give the date of th 
cessation. 

Gout. — The essential features to be borne in mind as 
to gout relate mainly to the causes and to the anatomicae 



48 LIFE INSURANCE EXAMINATIONS. 

characters. The family history presents a guirle as to 
hereditary transmission, which is recogn'zed as etiological 
by medical authorities, and has been so apparent in 
medico-insurance matters that many companies go so far 
as to ask if the grandparents, uncles and aunts have had 
gout. If the answer is affirmative, it is further asked if 
it is on the father or mother's side of the family. This 
calls attention to the so-called '* law of atavism/' which 
appears so prominently in life insurance experience. As 
a cause of gout the most prominent we find are errors re- 
lating to food, drink and exercise. In general terms these 
errors may be summed up as excessive eating, especially 
of particular articles of food ; undue indulgence in alco- 
holic drinks, and indolent habits, with deficient exercise. 
Bodily conformation and temperament have been credited 
with a predisposing influence, persons of sanguine tem- 
perament, aud of corpulent full-blooded, plethoric habit of 
body, being supposed to be most subject to the disease and 
to have it in its most acute form. Social position and oc- 
cupation materially influence the occurence of gout. It is 
a well-known fact that it tends specially to attack the 
smaller joints, an I above all the metatarsophalangeal joint 
of the great toe, which is the one usually first affected. In 
its most typical manifestations gout is characterized ana- 
tomically by the occurrence of a peculiar form of inflamma- 
tion affecting certain joints, this being invariably attended 
with the deposit of urates in connection with their struc- 
tures. In a progressive case, the joint then becomes per- 
manently enlarged and distorted, while the ligaments are 
thickened and more or less stiff or quite rigid, and ulti- 
mately complete anchylosis may be produced. The 
condition of the kidneys induced by the gouty diathesis 



LIFE INSURANCE EXAMINATIONS. 49 

is of great importance, and these organs probably begin 
to be (lisease^i at a very early period in the history of a 
case of gout, for tbey may be found to be affected when 
there have been little or no external manifestations of 
the complaint, commencing with a deposit of urate of 
soda within the renal tubuli, a chronic inflammatory pro- 
cess is set up, ending ultimately in the production of the 
granular contracted kidney. Other morbid states ob- 
served are the presence of calculi, consisting of uric acid, 
urates or oxalates, chronic cystitis or urethritis. 

Gout is regarded by some companies as a grave blot 
upon an applicant's family history. 

GOUT AND NEURASTHENIA. 

Dr. F. D. Grant, of the Provident Life, speaking of 
gout and neurasthenia in their relation to insurance, says 
Dr. Geo. M. Beard has set forth the whole history of neu- 
rasthenia in his classic work on that subject. I have 
always held his book in the highest estimation, and have 
considered that he about exhausted the subject upon 
which he spent so much of his time. But we are dealing 
with the gouty diathesis. Now, this to me is a distinct 
entity, and its symptoms, and the condition of the appli- 
cant for insurance, present a very different picture from 
the man with a gouty diathesis applying to us for insur- 
ance. The neurasthenic may be — indeed, often is — a 
neurotic, but he is not a sclerotic. The neurasthenic 
suffers much with his protein symptoms, but as a class 
he lives long. The gouty subject, or one with a strong 
tendency that way, has not the symptomatology of the 
neurasthenic; neither, in my experience, are his chances 
for expectancy as good. 

4 



60 LIFE INSURANCE EXAMINATIONS. 

When I am brought face to face with an applicant giv- 
ing the following liistoy, ani presenting the foil >wing 
symptoms, it is my practice either to decline outright, or 
to limit to an endowment policy for insurance, according 
to the merits of the case : — 

A man past 40, giving a gouty history in his family, 
or showing a gouty tendency in himself, wuo shows indi- 
cations of arterial tension in his arteries (the arterio- 
sclerosis of our medical nomenclature), who has the 
tortuous temporal artery and the accentuated second 
heart-sound, who may have also the beginning or com- 
plete arcus senilis (upon which Dr. Wood has spoken at 
length), and whose urine ei her shows a trace of albumin, 
or under the microscope casts, or, if not these patho- 
logical conditions, reveals a high specific gravity and 
excess of urates, is, to my mind, a gouty subject, and 
not a neurasthenic, whatever other symptoms he may 
give. I confess that I have personally a great respect 
for the presence of albumin in the urine under any con- 
ditions. It will, indeed, be a great boon conferred upon 
us all when the time arrives that some one in our profes- 
sion shall positively demonstrate the true significance of 
albumin in the urine, and its relation to the various 
diseases to which the human flesh is heir. At the present 
time we can only take our findings, and govern ourselves 
according to our individual opinions and judiiments on 
the signification of this abnormal element in the hucnan 
urine. 1 agree entirely with Dr. Lambert's statement, 
namely, that the nice distinction between the gouty dia- 
thesis and the chronic rheumatic conditions which come 
before us is a very fine one, and that it is often hard to 
draw the line of demarcation between them. 



LIFE INSURANCE EXAMINATIONS. 51 

There is another point I think it is well that we should 
remember ; that is the two forms of ^outy diaihesis which 
appear bef')re us in our work, namely, that in the rich, 
or well-fed, well-cared for ram, due to excessive meta- 
mori)hosis of tissue, and that in the poor or working 
classes, due to defective assimilation. The pictures which 
these two types present to us are very different, but the 
results are the same. It is the practice of our company 
to limit these subjects (when we do not decline) to some 
form of endowment insurance, either on a short or long 
endowment, according to the merits of the case. — Medi- 
cal Examiner. 

Gravel. — The same causes which produce dyspepsia 
are frequently productive of uric acid gravel, such as indo- 
lent habits, excess of food and drink. Gravel may be 
composed of uric acid and its compounds, oxa'ate of 
lime, phosphate of lime or the triple phosphates of lime, 
magn sia and ammonia. By far the most common form 
of gravel is the uric acid. This, owing to its great insolu- 
bility, is freqently deposited in the kidneys and blad<ier, 
and is seen in newly- passed u ine in the form of the 
well-known reddish-brown crystals, often described as 
resembliiiij cayenne pepper grains. The appearance of 
these crystals in any specimen should call forth hesita- 
tion in recommending a risk, and denaand a thorough in- 
ves'igation, the details of which should be communicated 
to the Medical Director. 

Headache. — A detailed description of the symptoms 
is called for. Relate the applicant's impression as to its 
cause and give the date when he observed it to be a mat- 
ter of annoyance or discomfort. Describe the seat of 
pain, and its limitations as to area. Then the character 



52 LIFE INSURANCE EXAMINATIONS. 

of the pain, for instance, as to whether it is dull, sharp, 
cutting, etc. Duration of the attack and treatment is of 
interest. State whether it is associated with perverted 
sensations, such as giddiness, tingling in the limbs, 
disordered hearing or disturbances of vision. Remember 
the relation between headache and rheumatism, syphilis, 
neuralgia, and uremia. 

Insanity. — The family history may contain an index 
pointing to inherited predisposition to neurotic disorder. 
This is difficult to estimate or discover, owing to the care 
with which it is concealed, but its importance cannot be 
questioned, and should call forih the greatest concern, 
and hence the most searching inquiry into any clew which 
may present itself. 

Lumps or Swellings. — For purposes of classification 
swellings are described as local or circumscribed, and as 
general or diffused. Among the circumscribed kind, 
hypertrophy of the thyroid gland, as in goitre, may be 
mentioned. Ordinary abscess may present itself and 
call for description. Edema, and other exudations into 
the connective tissue, merit mention. Disturbed relations 
of parts are often found, as in dislocation of the joints, 
and hernia. Inflammatory enlargements and new growths 
constitute by far the most common cause of local swell- 
ing, and they thus become of prime importance from a 
life insurance standpoint. Among the diffused swellings 
due attention should be paid to anasarca, myxodermia, etc. 

Malaria. — In the minds of many Medical Directors, 
malaria is classed with the proverbial "charity which 
covers a multitude of sins." 

Consumption, or the tendency to it, is usually suspected, 
and special effort is always required of the examiner to 



LIFE INSURANCE EXAMINATIONS. 53 

exclude phthisis and other wasting diseases. It is par- 
ticularly urged to learn as to whether the applicant had 
any couiih following the so-called malaria, and also 
whether the attack has had a recurrence. In a case in 
point the au'hor has just receive 1 the following specific 
instructions from a well-known Medical Director of ex- 
tended experience: " The postponement was due not to 
the fact that the applicant had malaria, but to informa- 
tion received from you that he was troubled with a cough 
for about three weeks after the attack of malaria. As 
undoubtedly you are aware, it is necessary to be very 
careful in regard to cases of so-called malaria, particu- 
larly when there is any cough associated with ihem. In 
Canada where there is no true malaria, an attack of the 
disease, so-called, is looked upon by physicians as being 
suspicious, being in so many cases the commencement of 
pulmonary disease, the initiatory symptoms of which 
simulate, by their intermittency, true malaria. Dr. Osier 
says that in all our cities the initiatory symptoms of con- 
sumption are very often mistaken for malaria. Make a 
re-examination of the lungs, and ascertain definitely in 
regard to any cough which he may have had since the 
malaria, and also take his temperature.'* 

Open Sores. — The etiology of ulcers furnishes a basis, 
which indicates the important bearing which they may 
have on life insurance. They may be caused by a cut or 
laceration, by pressure, by destru<'tion produced by an 
escharotic, a burn or a bruise ; or they may be the result 
of changps commencing within the tissues themselves. 
These changes might be acute inflammation, giving rise 
to pus ; chronic inflammation, giving rise to thickening 
of the fibrous tissues, with strangulation of the blood- 



54 LIFE INSURANCE EXAMINATIONS. 

vessels passing through it to the surface ; or defective 
nutrition of the skin and subcutaneous tissues. In giv- 
ing the details as to an open sore, describe the surface, 
the edges, the surroundings and the discharge. In this 
connection, il is well to bear in mind the classification of 
ulcers as given by Syme, who refers to the following 
varieties, viz. : 1. The healing or healthy. 2. Those 
that do noc heal, frotn defect of action. 3. Those that 
do not heal from excess of action. 4. Those that do not 
heal from peculiarity of action. Under the last heading, 
it is well to mention phagedenic and sloughing ulcers, 
such as bubo and venereal sores. Among the cases 
often encountered is a history of bone injury, in which a 
sinus is still operative. Varicose ulcers require notice 
and are a bar to life insurance. 

Pain in the Back — The many conditions which give 
rise to pain in this situation require to be borne in mind 
in m '^king examinauons. Amonsj these may be mentioned 
congestion of the kidneys, the diagnosis of which is em- 
phasized by scanty, high-colored urine, containing albu- 
men and blood corpuscles. 

In renal calculus the pain radiates forward from the 
renal site. The presence of a stricture of small calibre 
will often cause the patient to conciplain of pain in the 
back. 

Lumbago may depend upon rheumatism of the muscles, 
or it may be neuralo^ic in character. Pain in the back 
may be caused by flatulent distention of the bowels, or 
it may depend upon a tumor connected with the b )wels. 
An undiscovered hernia may have attention called to it 
by pain in the back. 

Movable kidney has its pain referred to the side on 



LIFE INSURANCE EXAMINATIONS* 55 

which the kidney is displaced, and is characterized by 
increased pain on assuming the erect posture. 

Paralysis. — This is a bar to life insurance while it is 
present, and, as a rule, after it has been recovered from, 
and its history becomes a matter of life insurance interest 
on account of its bearing on future examinations. An ap- 
plicant will, at one time, give a history of paralysis from 
which he appeared to have recovered, and in a subse- 
quent examination he will purposely omit this history, only 
to be confronted with it when the '* Clearing House" 
record discloses it to the Mfdical Director souglit to be 
imposed upon. In an effort to locate the cause of paraly- 
sis, it is well to go over some of the usual conditions which 
are said to favor it: Exposure to cold or damp, some 
shock or concussion, venereal excesses (onanism), great 
faliiiue, induced by other causes ; syphilis, the specific 
fevers, such as cholera, typhoid, variola, etc. 

Palpitation. — Being a symptom which is often admit- 
ted by an applicant, may or may not have a material bear- 
ing on the issue of the case. Hence, in addition to other 
essentials in every inquiry, the causes must be venti- 
lated. 

The chief predisposing causes are to be found in the 
nervous and excitable temperaments ; exhaustion from 
any cause, whether borJily or mental, venereal excesses, 
and in deterioration of the blood, as occurs in gmt, chlo- 
rosis, etc. Among the exciting causes may be classed 
violent exercise, mental shock, emotion and all forms of 
sudden excitement of the nervous system, dissipation and 
dyspepsia. 

Valvular disease, hypertrophy and cardiac dilatation, as 
well as myocardial affections, must be suspected in every 



56 LIFE INSURANCE EXAMINATIONS. 

case as important and serious causes. Tea, coffee and 
alcohol are frequent causes, as likewise excessive smokingc 

Piles. — In describing hemorrhoids, it is advisable to 
state whether they are of the external or the internal kind, 
also whether they have ever been strangulated, and if 
they have been accompanied by hemorrhage, mention the 
extent of the bleeding. The gravity of piles is based on 
the fact that external piles, when large and troublesome, 
and internal piles when of such a size as to protrude at 
stool, are apt to be subject to inflammation, ulceration, 
and frequent bleeding, and can be removed only by 
operation. In addition to costiveness as a cause of 
piles, it is well to note stricture of the rectum or urethra, 
and enlargement of the prostate gland, and the history 
of piles will necessitate a local examination and descrip- 
tion of the condition of the parts directly or indirectly 
involved, before the record will be complete. 

Rheumatism. — In commencing the catechism as to this 
disease, it should be recalled that inheritance figures in 
these cases, as it is claimed that it can be traced in about 
27 per cent of all cases. Previous attacks increase the 
liability to a return of the disease, but a limit is claimed 
to predisposition from this cause after several attacks. 
Among the determining causes are weather, season and 
climate, through the influence of exposure to cold and 
wet. Indulgence in rich or indigestible food may induce 
an attack in those who are predisposed, or laboring under 
depressing bodily or mental influences. Among the con- 
stant phenomena of rheumatism we find fever, sweats and 
arthritis, whilst inflammations of the cardiac structures, 
lungs and serous baembranes would be inclu<led under 
the head of occasional phenomena, or complications. 



LIFE INSURANCE EXAMINATIONS. 67 

The remote consequences of acute rheumatism are more 
serious than the immediate effects. A common effect is 
valvular disease of the heart, which is usually referable to 
endocnrditis occurring as a complication of rheumatism. 
It is impossible to estimate the number of cases of diS' 
ease of the lungs, vessels, brain, kidneys and other 
organs, which follow in the wake of such heart diseases. 
When, in addition to these effects, we consider the remote 
effects of pneumonia and pleurisy, and the liability of a 
return of rheum^ism after a first attack, it can be con- 
ceived with what deep concern the condition is viewed 
by medico-insurance officials. Cardiac complications are 
said to figure in no fewer than 50 per cent of all cases. 
Among the special types of rheumatism, gonorrhoea! 
rheumatism must Cf^ll for special mention, and equally 
special investigation by the examiner. 

An attack of acute articular rheumatism disqualifies 
for one year after beginning of convalescence. Recurring 
attacks may disqualify permanently. Chronic rheuma- 
tism disqualifies variously according to case. 

Rupture. — All hernial protrusions are classed as re- 
ducible or irreducible, and the admission or discovery of 
a hernia involves a close description of the anatomical 
conditions, so that a proper estimate can be made as to its 
bearing on the life insurance question. The treatment 
of all reducible hernias being based on the employment 
of means to prevent its protrusion, these means merit a 
critical inspection by the examiner, and a corresponding 
report to the Medical Director. Upon the issuance of a 
policy to the subject of a rupture, many companies attach 
a " hernia clause," obligating the applicant to employ a 
well fitting truss during the life of the policy. In addi- 



68 LIFE INSURANCE EXAMINATIONS. 

tion to the ordinary question as to the rupture, some 
companies append an additional question, " If there is a 
rupture, of what kind is it? is it reducible? and is a truss 
worn?'' 

Scrofula. — Althouo^h a term relatinoj to a nomencla- 
ture which is almost obsolete, this calls attention to certain 
morbid affections of the absorbent glands. Modern re- 
search has demonstrated that a scrofulous gland is really 
a tuberculous gland. Vulnerabihty is the type which is 
presented by these cases, and association of bad family 
history and scrofula would disqualify for insurance, as 
likely to impair the normal resistance to disease. Com^ 
monly the inflammatory products of the strumous dia- 
thesis remain where they were produced, inert and passive, 
so that they can be readily made out by the examiner. 
Whatever lessens health and strength tends to beget 
scrofula; and tends to beget it, not so much in the enfee- 
bled individual himself, as in his offspring, all of which 
is only another demonstration of the value of family 
history in insurance rating. 

Skin Disease. — These are often only local manifesta- 
tions of lack of healthy function and normal vital power, 
and a proper examination from particular to general may 
disclose matter of much moment to the question at issue. 
Among the common inflammations, eczema in its multiple 
forms may be the reflection of diabetes or other grave 
conditions. In the absence of an honest or candid state- 
ment as to syphilis, the syphilides may obtrude them- 
selves and speak volumes to the inquiring examiner. 
The tendency of certain diseases to present local evidence 
on the hands and face is often a distinct aid in clearing up 
an otherwise obscure case. Puflftueaa Of the lids and pasty 



LIFE INSURANCE EXAMINATIONS. 59 

complexion are often the only outward signs indicating 
Bright's disease. Discoloration of the skin excites in- 
terest, as one of the symptoms of Addison's disease. 
Whatever the skin manifestations may be, it should not 
be lightly dismissed, but should call for an absolute diag- 
nosis as to its cause, etc. 

Spitting of Blood. — Hemoptysis, having its source in 
pulmonary or bronchial hemorrhage, is a condition so 
grave that no after-coloring of the picture by the appli- 
cant ever admits him to the good graces of the Medical 
Director. It is one of the most ficquent signs of early 
ph'hisis, as well as being an accompaniment of the later 
forms of the disease. No modification in the views re- 
specting the nature of plithisis can lessen the significance 
of hemoptysis as being one of its most important signs. 
Whi'e it is a warning that may sometimes save, and very 
often prolong life, yet, as a rule, it operates as a pre- 
ventive as^ainst the issuance of a policy. Hence, its 
history should be thoroughly elaborated, and all of its 
essential features submitted, and when the examination is 
made the chest should be so examined as to preclude 
any doubt as to the present condition at least. In giving 
the history mention the quantity of bloorl, as well as its 
character and the number of times it occurred, and the 
date of its last appearance. After all is said and done, 
howHver, the statistics of the company are embellished 
by an interesting history, but generally no cash follows 
into its treasury from the blood-spitting applicant. 

Stricture of the Urethra. — However frequent stric- 
tare may be found in practice, it is rarelv admitted hy an 
applicant, and, if admitted at all, tie mentions that the 
stricture was slight, and that it is cured, and gives him 



60 LIFE INSURANCE EXAMINATIONS. 

no trouble now, A visual inspection of the act of urina- 
tion may disclose to the examiner the amount of reliance 
which is to be placed in the applicant's statement. It is 
the practice of some Medical Directors to order an ex- 
amination of the urethra by the introduction of an ap- 
propriate sound, and if its calibre is found to be normal 
the case presents a favorable appearance. The writer 
was asked by a possible applicant what was the custom 
of the companies as to stricture, of which he claimed to 
have been cured. Upon disclosing to him the usual test 
of sounding the urethra, I failed to have the satisfaction 
of examininor him, but subsequently learned that he had 
been examined by another examiner to whom he did not 
disclose any history of stricture. 

Swelling of the Feet.— This excites attention as 
being one of the first manifestations of cardiac disease, 
and becomes apparent if the subject of it has been for 
some time in an upright position. If present at the 
time of examination it would cast a cloud on the record, 
with or without other concomitant symptoms. If it is 
merely a history of the past, it should not be dismissed 
lightly, but due search should be instituted for indica- 
tions of cardiac abnormality, or Bright's disease. 

Syphilis. — The question of syphilis has come to be a 
bugbear in the life insurance field. An applicant will 
sometimes say that he had a " chancre," but a scientific 
inquiry may disclose the condition to have been ''chan- 
croid," as the laity still confuse the terms, or an en- 
lightened quack may have impressed a diagnosis of 
^'chancre " upon a case of herpes progenitalis, thereby 
increasing his emoluments and magnifying the gravity of 
the condition, as well as his skill in curing it. 



Lit'E INSURANCE EXAMINATIONS. 61 

Whether syphilis can or cannot with safety be insured 
is a question which is siill ^' sub-judice." No invariable 
rule as to accept^ince can be laid down, bui each case is 
considered on its merits. No applicant with a syphilitic 
history is favorably considered until a sutificient time has 
elapsed after he has been cured. What constitutes a 
'* sufficient time " discloses the widely different opinions 
which are held on this subj^^ct by the various Medical 
Directors. There is no consensus of opinion on the 
matter. However, no applicant will be accepted who is 
the subject of tertiary or inherited syphilis. When an 
applicant who has had syphilis is presented, a full sym- 
tomatic and chronological history of the disease is re- 
quired, together with the treatment employed and the 
name and residence of the attending physician. In the 
event that a syphilitic applicant is married, state how 
long he has been married, and whether he has had any 
children. If so, are the children perfectly healthy? 
Has his wife miscarried ? Is she now perfectly well, and 
has she been so since marriage? 

An eminent German authority who has studied the 
influence of syphilis upon insurance mortality is of the 
opinion that at least 25 per cent, of deaths from heart 
disease, hemorrhage into the brain, and cerebral softening 
in persons under 50, wrthout distinct specific history, 
should be placed at the door of syphilis. 

Jonathan Hutchison, a very great authority on syphilis, 
said he should only like to belong to a syphilitic life 
assurance society at ordinary rates, and contends that if 
a man has undergone a certain amount of treatment three 
or four years, and shows no sign, and shows himself to 
be in a good state of health, he is pretty safe. 



62 LIFE INSURANCE EXAM^ATIONS* 

Varicose Veins. — A dilated vein becomes dangerous 
in proportion to its tencieocy to rupture or to mfl «mma- 
tion. In describing a case of varicose veins, mention 
wbeiher the varicosity extends above the knees and also 
whether a proper support is worn. N )te if there is any 
tendency to breaking down or ulceration. A varicose 
ulcer would work as a bar to life insurance. If there is a 
varicocele, state whether this is slight or well marked, 
and also whether applicant wears a proper suspensory 
bandage for same. Pulsating varices call for special 
mention. 

Have you had any illness or disease other than as 
stated by above (state full particulars)? If the answer 
is aflSrmative say, ''none except,'' giving the necessary 
details, etc. 

A simple description without the qualification in quo- 
tation maiks would not be a complete answer to the 
question. 

APPENDICITIS. 

Rule in Reference to Appendicitis. — Six varieties are 
recognized: — 

1st. Non suppurative with no operation — appendix not 
removed — disqualifies until after two years. 

2d. Non-suppurative, appendix removed, disqualifies 
until after one year. 

3d. Suppurative — if clearly shown that the appendix 
has sloughed away with perfect recovery — disqualifies 
until one and a half years at least from date of recovery, 

4th. Abscess drained and appendix not removed — 
disqualifies until two years after perfect recovery. 

5th. Chronic, relapsing or recurring, disqualifies unti 



LIFE INSURANCE EXAMINATIONS. 6S 

five years have passed with no recurrence of symptoms 
wilhin that time. 

6ih. With a history of general peritonitis — excHon 
of appendix — one year after perfect recovery, provided 
the appendix has been perfectly removed. If it has not 
been, three years after recovery. 

MEDICAL EXAMINER'S REPORT. 

Were you and the applicant alone for this £xamination? 

The prest^nee of a third person is absc>lutely forbidden 
in the making of examinations. The reason for this is 
obvious, as it insures a greater degree of candor from the 
applicant, when he is assured that his disclosures as to 
family and personal history are guarded by the seal of 
confidence. It also prevents coaching or suggestion from 
an interested third person, which character the agent often 
likes to assume, if permitted by an indulgent examiner. 

Do you personally know the applicant f 

This often works to the advantage of the applicant, 
when answered affirmatively, as an admi-:sion of a personal 
acquaintance without some adverse comment, tacitly Im- 
pHes an indorsement of his reliability of statement as to 
habits, etc. 

On the other hand, if the examiner should have per 
sonal knowledge of the facts bearing on the case, he would 
be in duty bound to communicate them. 

Does the applicant's appearance indicate health and 
vigor f 

This question is devised to arouse the examiner's powers 
of observation, so as to form an impression as to whether 
the applicant, on his outward appearance, would seem to 
present a normal resistance to disease. Collaterally, it in - 



64 LIFE INSURANCE EXAMINATIONS. 

vites an opinion based on the impression which is left on 
the examioer — after hearing the applicant's stO'-y of pre- 
vious illness, etc., in his '' declarations to the examiner." 

Marks OF Identification. — If none are apparent, auk: 

How could your body be identified if much disfigured, 
or if no friends were near? 

This will lead to what the applicant considers to be a 
characteristic. 

Describe marks of identification in detail, 

A well-known examiner once sent in an answer as fol- 
lows: '* parts his hair in the middle." 

Physical Marks. — Such as crooked fingers, moles, 
scars, tattoo devices, etc., are reliable means of identifi- 
cation and should be recorded. 

Complexion. — -This term is generally used to denote 
the color of the face, whether pale, dark, ruddy, sallow. 
The color of the hair and eyes should also be mentioned 
in this connection. 

Color of the Hair. — If the hair is white, does it cor- 
respond with the applicant's age? or is it a family char- 
acteristic, or has it been brought about suddenly by great 
mental shock? 

Is it evident that it has been changed by the use of 
chemicals? 

It has been observed that the man who dyes his hair, 
fools nobody but himself. 

Race. — State whether white or black or other distinc- 
tive race. The writer knows of an examiner who on one 
occasion returned an examination with the answer " Jew- 
ish race," thereby arousing the ire of the Hebrew agent, 
who protested that this was a designation of a religion 
and not of a race. 



LIFE INSURANCE EXAMINATIONS. G5 

Complexion and Build. — A flat chest, a pigeon-breast, 
a protuberant abdomen, should be noted and a compre- 
hensive description given. 

In answer to '' Figure *' state whether robust or spare, 
erect or stooping. 

Height and Weight. — In a report by a well-known 
Medical Director, he sums up as follows : — 

" That persons who are under the standard or average 
of weight are much more liable to consumption than 
those above this standard. That persons who exhibit a 
robust and well-developed body have little suscepubility 
to consumption. That the personal condition of weight 
and robustness has far more value than the family history 
in diminishing the liability to consumption ; and that 
therefore, the evidence presented by a well-developed 
body may outweigh the suspicion attached to unfavorable 
record.*' 

Underweight should be carefully scrutinized, as indi- 
cating a tendency to consumption, or other wasting pro- 
cess. 

Overweight. — Frequently exhibits a tendency to dis- 
eases of the heart, arteries, liver and kidneys, as well as 
fatty degeneration. 

Stillman says that excessive ol?esity at any age vitiates 
the risk, and this is especially true if it has appeared 
with comparative suddenness, and cannot be recog- 
nized as an inherited tendency in an otherwise healthy 
family. 

As a concise statement of the influence of height and 
weight, I make use of the concluding passage in Dr. Geo. 
R. SUepherd's paper read before the Association of Life 
Insurance Medical Directors of America at its meeting in 

5 



i^6 LIFE INSURANCE EXAMINATIONS. 

1899. I have excerpted same from The Medical Examiner 
of July, 1899 : — 

" It may be interesting to consider for a moment some 
of tlie causes of thQ variations in build. 

" There is the influence of heredity which is frequently 
well marked, all the members of a family, sometimes for 
several generations, showing this as a characteristic both 
in light and heavy weight. Not iofr^quently this is 
coupled with longevity, the individuals being of the thin, 
wiry, tough race, who endure well the hardsnips and labor 
of life, or, less frequently, of the opposite build, hea^y 
frame, well-developed muscle, large chest capacity, and 
great endurance. But on the other hand, there is a class 
in which tlie ancestry has been shortlived, tuberculosis and 
nervous diseases beinor found among those of the one class 
and heart disease, apoplexy and renal troubles with the 
other. These must be looked upon with great suspicion." 

Uuderweiuht is often the result of digestive disord-rs 
causing malnutrition. Spirit drinking, poor and insuffi- 
cient food, and overwork, are frequently causes of light 
weight. 

Over-indulgence in food and drink, particularly if the 
food be starchy or saccharine, and the drink malt liquor, 
is a frequent cause of obesity. 

Butchers who spend much of their time in the slaugh- 
ter house are usually of heavy build. Some men take on 
fat quite su Idenly owing to ohanofe in habits of life. 
Such risks are always hazardous. The muscles are weak 
and hernia is of frequent occurrence. 

There appears to be some reason to believe that there is 
a class of light weights who are of a wiry, tough make-up, 
mostly bone and sinew, who have good resisting power 



LIFE INSURANCE EXAMINATIONS. 67 

and are long lived, like their ancestors, and also that we 
do occasionally see a man of heavy build who is chiefly 
bone and muscle, with a large frame and unusual devel- 
opment. These men form a class by themselves, and 
are not always poor risks. 

For many years it has been a settled opinion among 
many insurance authorities that lig'it weight means liabil- 
ity to consumption, and probably every company has de- 
clined to take such cases as a rule, accepting only such 
as could show an ancestry free from taint, particularly 
of tubercular disease, and a personal record that was 
equally clear. On the other hand, many companies have 
regarded heavy weight as a redeeming feature in a tuber- 
cular family, and when not so associated they have con- 
sidered it chiefly due to muscle and bone, as the agent, 
and not infrequently ttie medical examider, are so prone 
to assert. For this reason miny heavy men have been 
insured as good ri^ks, when their thin brothers were 
turned down as poor ones. Hence the number of heavy 
weigbts exceeds very greatly those of liglit weight in our 
statistics, but it appears quite clear from what is here 
presented that this has been a mistake. The over and 
the underweights alike are abnormal risks, and should be 
considered as giving evidence of ^susceptibility to disease 
with lessened vital resistance, particularly so if the fam- 
ily histo'-y is other than first class. The value of family 
history is beautifully illubtrated in the table furnished by 
the Northwestern. When the family record was " extra- 
ordinary," neither parent having died under 70, the over- 
weight was comparatively of small moment, but in the 
second class, where at least one parent had died under 
70, the result was marked. 



68 LIFE INSURANCE EXAMINATIONS. 

"Light weights may be said to be poor risks for the 
following reasons: — 

1st. They are abnormal and die short of their expecta- 
tion. 

2d. They are prone to develop tuberculosis and nerv- 
ous diseases. 

3d. They are frequently under-fed and over-worked, 
suffering from mal-assimilation. 

4lh. They are usually of a very nervous temperament, 
and so wear out quicker than men of ordinary build. 

The overweights are poor risks because : — 

1st. They are abnormal. 

2d. They are prone to develop heart disease, apoplexy 
and premature arterio-sclerosis. 

3d. They are peculiarly liable to diabetes, rheumatism 
and lithemia. 

4th. They take in«?uf!ident exercise and eat heartily as 
a rule, and frequently are in;emperate in the use of 
stimulants, particularly of malt liquors. 

5th. They succumb easily to accidents and surgical 
operations. 

In conclusion, therefore, we would say, first, that a va- 
riation of more than 20 per cent from our table, in 
either direction, should decline a life risk, except in a 
few rare instances where the build is a family character- 
istic coupled with longevity; or, second, in overweights, 
since the diseases to which they appear to be chiefly pre- 
disposed are due to changes that appear after middle 
life, as a rule, even when the family history is not extra 
good, many may safely be given a policy to terminate at 
about fifty years of age." 

Whenever it is practicable, the examiner should weigh 



LIFE INSURANCE EXAMINATIONS. 69 

and measure the applicant, and this becomes imperative 
upon him when the height and weight stated by the ap- 
plicant would seem to be improhahle. It should cer- 
tainly be done in all cases where the weight varies more 
than ten per cent from ihe schedules based upon the 
heij^ht. If it is not done, it will provoke correspondence 
with the home office, and at least delay the case ; whereas, 
if it is done, it will show that the examiner is mindful of 
the essentials of his duty in the matter. As a rule of 
thumb, it may be estimated that a man of live feet will 
weigh between 110 and 115 pounds, and five pounds 
may be addt^d for each inch of height. It is only in 
rare cases that any compiny will issue a policy upon an 
applicant who is 20 per cent or more tinder the scale of 
weiijht based upon his height. For inst ince. if it is a 
distinct family characteristic on both si<ies of the family. 
Some companies hesitate to issue upon a man who is 
more than 20 per cent over the schedule, hut, many com- 
panies will take cases as high as 40 per cent in excess. 

b. Circuoaference of chest on full " 

expiration inches 

c. Circumference of chest on forced ^tinder 
inspiration | ^'^^t 

d. Girth of abdomen inches J inches 
The measurement of the chest should be taken above 

the nipples, and if the applicant cannot make a satisfac- 
tory resfiiration, or catches his breath through nervous- 
ness in his effort, he should be taught how to properly 
ex[)and his chest bv an object lesson based upon watch- 
ing thp examiner do it. Some applicants become excited 
during the maneuver, so that when the pulse is taken a 
few moments later it is often found to be accelerated. In 



70 



LIFE INSURANCE EXAMINATIONS. 



consequence, some authorities have claimed that the 
pulse should be taken first, in order to have the appli- 
cant more quiet, whereas, other good authorities argue 
that if the applicant is subject to an irregular or inter- 
mittent pulse, it will become more manifest when the 
rate is fast. They ars^ue further that if it is fast from 
excitement only this may be alla3^ed by a few minutes' 
rest, and that a valuable test has been made by the very 
slight '' waking up " which the applicant gets. 

Did you iveigh and measure him? 

If not, are you satisfied that these figures are correct? 

It has been the writer's experience to measure an appli- 
cant, and weiiJ^h him on the scale found at his place of 
business, and subsequently a letter from the home office 
conveyed the information that the applicant had shown an 
increased weight of 15 11)S. to another examiner within, 
say, two weeks previously. In response to a request to 
have the applicant weighed again, he was weighed at the 
writer's office on a scale properly balanced, and the in- 
creased weight was found to he correct. Evidently the 
applicant had learned of his rejection by the other com- 
pany, and had " fixed " his scales, but, as the " clearing 
house " record disclosed the fraud, it is needless to say 
that he is now " fixed " so that he will hardly obtain addi- 
tional insurance in the future, even though his weighty 
disability may be removed. If the applicant is not 
weigher), he should, at least, be measured, and it should 
be so stated. In order to answer the question pro[)erly, 
the examiner should make a critical estimate based upon 
a careful study of the applicant's physique, and he should 
keep a note thereof, so as to be prepared for such addi- 
tional queries as he may receive from the Medical Director* 



LIFE INSURANCE EXAMINATIONS. 71 

Has the applicant s weight recently increased or dimiri' 
ished f 

If so, hotv much and ivithin ivhat period? 

The cause of ihe gain or loss must be given to f ulflU the 
requirements of this question. If it seems to be as a result 
of some morbid process, it will naturally imperil llie ri-k 
according to the gravity of the cause producing it. Ma- 
terial differences between winter and summer weights are 
criticised closely. 

The writer recently had an applicant tell him that he had 
gained 80 lbs. within a year. As a cause, he said his light 
weight was due to hard work in a cooper shop, while his 
heavy weight was a fam ly characteristic on both sides of 
the family, which tlie writer was able to verify fron per- 
sonal knowledge. The applicant had gained the 80 lbs. 
in any easy berth. 

If under or over weighty is it a family or individual 
characteristic? State on which side of family, dispro- 
portion exists. This question figures largely in the 
''strenuous Ufe " of the Medical Directors, if one is to 
judge by the earnestness and pointedness which mark 
their epistolary efforts to satisfy themselves on this 
point. If the examiner has personal knowledge as to the 
applicant's family, it is well to embellish the record by 
furnishing all possible information, as he will thereby 
often save some time and trouble, not only to the home 
office officials, but also to the ag^nt, and finally to him- 
self by sending a complete pen-picture of the case. 

If over weight, is it due to fat or to large bones and 
muscles? In cases where the weight is exces-ive, inquire 
of what it consists ; if of large bones and muscles, with 
eorrespondmg strength, it is evidence of large vitality ; 



72 LIFE INSURANCE EXAMINATIONS. 

but, if it consists of great deposits of fat, with a large 
abdomen, tlie conclusion must be unfavorable to the 
life. In cases where the increase of weight has been 
gradual ihe risk is to be regarded more favorably than in 
those in wbich the same condition has been rapidly ob- 
tained. 

Intemperance, either in eating or drinking, or both, 
and the absence of regular habits of exercise, are the 
usual causes of such rapid increase in size. 

In cases of extreme underweight or overweight, 
ascertain whether the condition is a family characteristic, 
and if it is, have applicant write and sign a statement, 
giving approximate weights of father, mother, brothers 
and sisters. 

Has the applicant ever had severe headaches^ vertigo^ 
fits or any nervous or muscular trouble? 

While it is not intended that the examiner shall at- 
tempt to throw the applicant into a " fit " to conform to 
this qut stion, it is yet imperative that any past trouble 
should be fully elaborated by description, and any re- 
maining effect must be mentioned. 

As to headaches, state whether it is confined to the 
forehead, the temples, the occiput or the vertex. The 
headaches which give most concern, in medico-insur- 
ance matters, are the so-called toxemic or uremic kind, 
which are usual'y accompanied by vertigo. If a history 
of such has been given, it is well to test the equilibrium 
of the applicant by causing him to do sr me stooping ex- 
ercise and assuming the erect posture quickly. The 
views of the examiner as to nervous symptoms or muscular 
trouble may be submitted under the above heading, after 
the applicant's whole case has been carefully considered. 



LIFE INSURANCE EXAMINATIONS. 73 

Has the applicant ever had syphilis, stricture or any 
disease oj the generative organs f The essential facts 
relating to stricture and syphilis are laid down under 
their rtspeciive headings. As to the diseases of the gen- 
erative organs the utmost care and exactness must be 
employed, so that the previous and present condition may 
be set before the Medical Director, as otherwise no intelli- 
gent estimate can be made as to the insurability of the life. 

7s there any eruption on any part of the body? 

While it is not contemplated that the examiner should 
present all the special knowledge of the trained derma- 
tologist, it is yet expected that such skin lesions as are 
apparent should receive a comprehensive description. 
The reason for this becomes obvious in view of the [)0S- 
sible bearing which they may have on the applicant's his- 
tory of previous illness. 

Is there any discharge from the ear? 

The indications for the proper method of answering this 
question aie mentioned under the appropriate heading. 

Has the applicant any cough or hoarseness at the pres- 
ent time? 

Many agents have a habit of rushing an applicant into 
an examination, nolens volens, although they know that 
the applicant has a cough at the time. These cases re- 
quire tactful handling, and shoul I not be recommended 
until the applicant is entirely free from ailment. 

Is the respiratory murmur clear and distinct over every 
part of both lungs? 

Is the respiration full, easy and regular? 

Is there any indication of disease of the organs of res- 
piration ? 

Number of respirations per minute ? 



74 LIFE INSURANCE EXAMINATIONS. 

In examining: the chest, it is absolutely necessary that 
the examiner should he afforde<l a favorable opportunity 
to recognize anythinor abnormal, if present. Henc^e no 
examination should be ma^le over the outer shirt. This 
should be removed, or at least raised up, so that the 
examining ear or stethoscope or phonendoseope may be 
conveniently placed for a proper recognition of the sounds 
which are heard, free from extraneous conditions, such 
as shirt-sounds or a noisy room, or like disturbances. In 
this way only can the shape of the chest be exactly 
noted. A normal chest should be symmetrical, full and 
well f-rmed. If there is a deviation from these normal 
characters, state the degree, etc. Describe deforruities 
of the chest, whether bilateral or unilateral. Among the 
abnormaliiies sometimes found are the so-called '' chicken 
breast " or '' pigeon breast," rickety ehest, alar or ptery- 
goid chest, phthisical chest; enlargement and contrac- 
tions, phthisical apices, and pleuritic effusions. The 
expansion of the chest should be at least one-tenth of the 
normal chest measurenaent. Teach the applicant how to 
expand, before deciding on the l.ck of proper expansion. 
Regarding the number of respirations, any deviation from 
the normal or usual relation between the pulse and respira- 
tion will d mand explanation sufficient to remove all 
elements of possible hazard. The spaces below the 
clavicles and their condition present reliable guides to the 
examiner. Be sure to observe whether they are de- 
pressed, and if dull and flit sounds are manifest on per- 
cussion. The breathing at these points is important. If 
abnormal these same concomitant symptoms will very 
likely also become apparent by the usual methods of 
physical diagnosis. 



LIFE INSURANCE EXAMINATIONS. 75 

Is the action of the h^^ art free, uniform and steady? 

-4?v its sounds 071 d rhuthm regular and iv>rmalf 

Is there any indication of disease of the heart and blood 
vessels 9 

The examiner will be held to a strict accountability as 
to tbe cardiac conditions. If alinormaliiy becomes ap- 
parent, describe it accurately, and while no one with cardiac 
trouble will be accepted as a select risk, yet ihe informa- 
tion as to the character of the disqualification is desirable 
for purposes of statistics, and as a guide, should the appli- 
cant be submitted subsequently as a sub-standard risk. 

What is ihe character of the pulse ? 

Is if intermittent, irregular or unsteady? 

What is the pulse rate? 

In countino; the pulse, it is always desirable to observe 
its rate throu2:hout an entire minute, inasmuch as im- 
portant irregularities in its action might otherwise escape 
observation. Should any deviation from the normal con- 
dition of the heart and lungs be discovered by auscuka- 
tion or percussion, which may be due to slight and tem- 
porary derauijements, such for instance as the sounds 
produced by a "cold,'' sufficient interval should always 
be allowed between their detection and the le-exaraina- 
tion to establish their true character, and the report 
should never be completed until these can be explained 
beyond a doubt. 

The character of the pulse may be described as normal, 
or, as full, strong and regular, and any deviations from 
these characteristics must be duly noted. If a heart 
lesion is diagnosticated, the record mi^ht be embellished 
by learning if there las been dyspnoea, palpitation, 
dropsy, or other symptoms. 



76 LIFE INSURANCE EXAMINATIONS. 

Is there any disease or disorder of the stomach or abdom- 
inal organs 9 

To answer this question, full attention sh >uld be given 
to the history as given in the decla?ations to the exam- 
iner, and the organs said to have been affected should be 
critically invest'gated. Having specially in mind the 
prevalence of hepatic troubles, several companies ask the 
question, ^^ Is the hepatic area sensitive on percussion or 
enlarged or diminished in size f " 

If a relation of appendicitis has been given, it will be 
advisable to sum up the case by placing it in the appro- 
priate category, as given under the heading " appendi- 
citis." If this is not done by the examiner, in the first 
instance, it will require correspondence and another inter- 
view, at least, before the MH(iical Director will be satis- 
fied to pass on the case. All cases of d} sp^^psia or indi- 
gestion should here receive a mental review from the ex- 
aminer, so as to determine their bearing, if serious, upon 
the question at issue. All histoiies of colic, if severe, 
protracted or repeated, and especially if due to renal or 
hepatic derangement, will call for the examiner's opinion 
before the case will receive the finishing touch of the 
Medical Director. 

Is there any indication of disease of the urinary organs? 

An admission of an attack of gravel, or other bladder 
trouble, or a gonorrhoea with its sequence of stricture, 
makes it incumbent upon the examiner to give his im 
pressions of the existing condition at the time of exam- 
ination. 

Immediate centrifugation and microscopic uranalysis, 
in a cool room, should disclose valuable inforojation as 
to the vesical state. The calibre of the urethra as dis- 



LIFE INSURANCE EXAMINATIONS. 77 

closed by the sound, is held to indicate the gravity of 
stricture. The uranalysis, chemical at least, and micro- 
scopic if necessar}^ will complete the requirement of this 
question. 

URANALYSIS. 

After satisfying himself beyond a doubt that the spec- 
imen examined by him is that of the applicant, the exam- 
iner faces one of the most important features of his 
work, viz., the uranalysis. 

For life insurance purposes, the scope of uranalysis 
embraces the following points of observation: — 

Color, whether clear or turbid ; 

Reaction, specific gravity, albumin, sugar; 

Nature and amount of sediment. 

A microscopic examination is to be made when the 
examiner deems it advi^ble, or the home office calls for 
it, either specifically or in accordance with the rules of 
the company. 

Among the physical characters of the urine the color 
engages the attention of the examiner at once. The 
color of normal urine is said to be amber, and the vari- 
ations from this standard are dependent upon the amount 
of coloring matter which it contains. When the urine is 
dense the color deepens, and on the other hand it may 
be almost colorless following the free drinkinijof water or 
other fluids. When there is any material variation from 
the normal color it is advis xUle to inquire as to the amount 
and character of food and drink ingested, say within the 
preceding three hours. A pale yellow urine, with its 
frothy surface, is found in the free flow of diabetes. Among 
the striking colors, an orange-red is observed from the 



78 LIFE INSURANCE EXAMINATIONS. 

elimination of santonin in an alkaline merlium. A reddish 
urine is usual after a full meal witliout mucb liqui'ls, and 
also after severe pliysical exercise and with abundant 
perspiration. A brownish urine excites attention from 
a possible hemoglobinuria, or as a sequence to the ad- 
ministration of tar, carbolic acid, gallic acid, tannic acid, 
senna, or sulphonal. A sulphur-yellow or olive-green color 
will be found associated with jaundice. 

Specific Gravity. — The urinometer is used for de- 
termining this point, and the insurance standard allows a 
variation between 1012 and 1030. If below 1012or above 
1030 other specimens must be examined. The free use 
of beverages may be the cause of the low specific gravity, 
and as few applicants are likely to drink too much water, 
it is in order to inquire the nature of ihe drinks which 
may bave caused the condition. The usual pathological 
state which is an accompaniment of light weigbt urine is 
diabetes insipidus, and it is also remarked in Bright's 
disease, with drficieut elimination of urea. 

When the record is above 1030 it points to an excess 
of uraeic products, and to sugar. Before having recourse 
to the chemical tests, it is well to inquire as to the daily 
quantity passed, and also as to whether the applicant is 
obliged to get up at niglit to void urine, and how often. 

Purdy in his work on practical uranalysis and urinary 
diagnosis calls attention to some fallacies which are en- 
countered in the Vise of the urinometer: 

"A more simple instrument, better suited for general 
practice, is one constructed on the principle of a 
hydrometer, termed the urinometer. If carefully con- 
structed and properly corrected, such an instrument will 
answer all practical purposes. * * * 



LIFE INSlIRANOi: EX^VMINATIONS. 79 

"The temperature of the urine immediately after being 
voided ranges from 85° to 95° F. ; therefore, in taklnor the 
specific gravity oi freshly voided urine, before cooling, its 
temperature should be observed, and for every 7 degrees 
of temperature the thermometer indicates above that upon 
which the urinometer is standardized, 1 degree should be 
added to the specific gravity of the urine in addition to 
that indicated by the urinometer. This is important in 
the case of i he old urinometers, many of which are stand- 
ardizeii at 60° F., permitting, as will be seen, an error of 
4 or 5 degrees with freshly voided urine if the above 
correction be neglected." 

Reaction. — In taking the reaction the usual procedure 
is the use of blue and red litmus paper, or the recent 
modiScation of " neutral" litmus paper, which latter is 
turned red by acids and blue by alkalies. 

The acid reaction is due to the dissolved acid phos- 
phates, and sometimes to the urates. Occasionally the 
urine will be found to be alkaline or neutral during the 
first or second hour after a full meal. This may be 
caused by an excess of the alkaline salts in the food. In 
this event, the blue reaction persists in the paper, in- 
dicating fixed alkali, viz. : the alkaline salts of sodium 
and potas^um. The same reaction mav be manifest if 
the applicant happens to be undergoing the so-called 
alkaline treatment of rheumatism. If the paper becomes 
blue through the volatile alkali, that is, ammonia, it will 
be gradually restored to its original color as the 
ammonia volatilizes. Alkaline urine, due to fixed alkali, 
does not tend to form calculi, but if due to volatile 
alkali the tendency is to form concretions in the bladder, 



80 LIFE INSURANCE EXAMINATIONS. 

and to create serious bladder trouble. The so-called 
" mixed phosphate ** calculus is frequently the attendant 
result. 

Albumin. — When albumin escapes into the urine it 
remains dissolved, as it does in the blood-serum, and can 
only be detected by reagents which char.ge it to an in- 
soluble conapound or coagulum. The persistent appear- 
ance of albumm in the urine is a bar to life insurance, 
although, it may be added, the opinions of many Medical 
Directors seem to have been modified recently, as many 
cases are now postponed, whereas formerly they were 
promptly declined. Unless accompanied by casts, albu- 
min is not entirely conclusive of kidney disease. It has 
been remarked that the most fatal form of Bright's disease, 
contracted kidney, has little or no albumin. In the 
presence of an applicant who is a ''club man'' or has 
been addicted to the steady use of liquor, it is recom- 
mended to make a microscopic uranalysis — when a trace 
or small amount of albumin is evident. The causes of 
albuminuria are summarized by Purdy as follows: (1) 
changes in the kidneys themselves, which impair the in- 
tegrity of the structures between the vessels and the 
excretory channels of the organs ; (2) alterations in the 
quality of the blood, which renders its serum-albumin 
more diffusible; (3) alterations in the d gree of blood 
pressure. Albuminuria may depend upon one, or indeed 
all three of the above conditions. Before proceeding to 
test for albutnin, all lurbidity should be removed by fil- 
tration. A small cone of filter-paper may be set in the 
mouth of a test tube, and the urine poure 1 through it. 
Among the many tests for albumin, Heller's contact-test^ 



LIFE INSURANCE EXAMINATIONS. 81 

Purdy's test^ and Esbach*s albuminometer^ hold popular 
favor among the medical examiners, possibly in the order 
named. 

Heller's test is applied by gently floating the urine 
upon a column of pure nitric acid, previously placed in 
the bottom of a test tube. It is recommended to make 
the amounts of urine and acid as nearly equal as possible. 
To prevent the mixing of the acid and urine, it will be 
necessary to hold the test tube in an inclined position, 
and allow the urine to flow gently down the inside of the 
tube until contact is had. Albumin is indicated by a 
white zone at the point of contact. This should not be 
confused with a certain brownish cloud, which is mani- 
fested by the amorphous urates, in concentrated urine. 
These precipitated urates disappear upon the application 
of gentle heat. 

Purdy's test^ or the ferrocyanic test, is described as 
follows : Into the bottom of a clean test-tube is poured 
15 to 30 drops of acetic acid, then about two or three 
times that amount of solution of potassium ferrocyanide 
(1-20) is added, and the two thoroughly mingled by shak- 
ing the tube. The urine is next added, to the depth of 
two-thirds of the test-tube. If albumin be present it will 
be precipitated throughout the whole volume of the urine 
in the form of a more or less milk-like, flocculent cloud, 
according to the quantity of albumin present. 

'^ Any precipitate produced by this test, when applied as 
above, is albumin^ and nothing but albumin.'* — Purdy*$ 
Practical Uranalysis and Urinary Diagnosis. 

Esbach's albuminometer is used to estimate the weight 
of albumin and is a graduated test-tube, which may be 

6 



S2 MFE INSURANCE EXAMINATIONS. 

obtained from all dealers in physicians' supplies. The 
formula for E-baeh's solution is as follows: — 

Dissolve 10 grammes of picric acid, and 20 grammes 
of citric acid in 900 C. C. of boiling distilled water; after 
cooling add sufficient water to make 1000 C. C. 

The citric acid is used to overcome any possible alka- 
linity in the urine. Fill the graduated tube with urine 
up to the mark U, and then add the solution to K; close 
with a stopper or with the thumb, and mix the ingredi- 
ents without shaking, by slowly reversing the tube about 
twelve times. After standing upright for some time, the 
coagulated albumin is apparent, and when it has precipi- 
tated as a sediment, the proportion may be read as indi- 
cated by the scale on the glass, showing the number of 
grammes of albumin to the litre of urine. 

TanreVs test^ or potassio-mercuric iodide test^ merits 
mention, and has a distinct value in making tests for life 
insurance. Its formula is as follows : 

Potassium iodide 3.32 grammes 

Bichloride of mercury 1.35 grammes 

Aceiic acid 20 C. C. 

Disiilled water to 100 C. C. 

Dissolve the potassium iodide and the mercury bichlo- 
ride separately in water, and mix the solutions ; then add 
the acetic acid, and make the whole to 100 C. C. with 
distilled water. 

Serum-albumin, peptone, alburaose, alkaloids^ and bile 
acids are precipitated by this reagent. 

The writer has made a routine practice of starting the 
chemical uranalysis with this test, and if albumin was 
subsequently excluded by Heller's or Purdy'stest, a cat- 



tiFE INSURANCE EXAMINATIONS. 83 

echism of the applicant has sometimps rlisclosed the faet 
that he was using some alkaloid, or has called attention 
to a hepatic derangement which was admittedly being 
treated, although such treatment was previously denied. 

The relation between albumin and Bright's disease naay 
^be elaborated by the following inquiry : — 

When and how was it first discovered? 

A. How often has it been found and when? 

B. How often not found and when? 

Does he suffer with lassitude, sleeplessness, headache, 
vertigo, dyspnoea, gastric disturbances, or alteration of 
vision ? 

Is there a history of dropsy, oedema of feet, or puffl- 
ness of eyelids? 

Does his appearance show ansemia or pasty com- 
plexion ? 

Do the vessels show atheroma, and is the pulse hard 
and of high tension ? 

Is there any hypertrophy of the heart and accentuation 
of the second aortic sound ? 

Has he noticed increase or diminution in quantity and 
frequency of micturition? 

Does he arise at night to void urine, and how often? 

Sugar. — '' The generally accepted beUef is that sugar 
is absent from healthy urine. It is always advisable be- 
fore testing for glucose to make sure of the iibsence of 
albumin." — Holland. 

"The continued excretion of grape sugar in appre- 
ciable quantities belongs exclusively to diabetes mellitus, 
and it is the most certain symptom of that disease. Its 
great clinical importance lies in the fact that it ordinarily 



84 ' LIFE INSURANCE EXAMINATIONS. 

becomes apparent at a time when all other symptoms of 
diabete-i are wautinoj. In such eases, however, one can 
be certain that (iiabetes exists only when, by repeated 
invesligation, grape sugar is found, and especially when lis 
quantity i^ observed to increase with the adminisiration 
of other carbohydrates, as cane-sugar, and stiii better, 
starch." — Von Jaksch. 

Alcohol seems to favor the appearance of glycosuria. 

Holland's Fehling solution presents a reliable test for 
sugar, and may be made by dissolving 28 grains of cop- 
per sulphate in an ounce of puie glycerine. Add about 
5 drops of this solution to an inca of liquor potassa. 
Tne mixture will produce a blue solution, which should 
be brought to the boiling point. Then add about 10 drops 
of the suspected urine, and boil the top of the column, 
and the presence of sugar will manifest itself by the char- 
acteristic reduction of the copper solution. 

The presence of the earthy phosphates will change all 
forms of Febling's solution by precipitating a grayish de- 
posit, which must be distinguished from the yellow or 
red precipitate, the latter alone denoting sugar. 

The Phenyl-hydrazia test^ which is characterized by 
Von Jakscu as preferable to all others, may be conducted 
as follows ; — 

"Two parts of phenyl hydrazine hydrochloride (say 
twice as much as will lie on the point of a knife- blade) and 
three parts of acetate of soda are placed together in a test- 
tube containing about two drams of urine. If the salts 
do not dissolve when the fluid is warmed, a little water 
should be added, and the test-tube containing tue mixture 
placed for 20 to 30 minutes in boiling water. After this 



LIFE INSURANCE EXAMINATIONS. 85 

take it out and place in a vessel containing cold water. 
If sugar be present, even in very moderate quantity, there 
forms directly a yellow crystalline deposit, which may ap- 
pear amorphous to tiie naked eye, but which when ex- 
amined under the micmsoope is seen to contain yellow 
needles detached or arranored in clusters. 

" If the urine holds but a very small proportion of sugar, 
the preparation should be placed in a conical gflass, and 
the sediment examined carefully. In a case where only a 
mere trace of sugar exists, detached crystals of phenyl- 
glucosazone cannot fail to be seen. The discovery of 
smaller and larger yellow scales, or of powerfully refract- 
insf brown srranules, must not, however, be mi'^taken for 
ev'd^nce of sugar."— CZmicaZ Diagnosis^ Prof. Von 

JnJcRCh, 

When the examiner has demonstrated the existence of 
glycosuria, its relation to diabetes may be made manifest 
by the foUowinor questions: ™ 

' * Does he suffer with thirst or hunger ? Has he ever had 
eczema, boils or carbuncles? Has he a cataract or any 
alteration of vision? Is he now on a restricted diet? 
Has he ever been treated for sugar in the urine ? When ? 
Has he noticed anv increase in quantity and frequency 
of urination? Does he arise a,t night to void urine and 
how often? " — Security Trust and Life Insurance Co. 
of N. T. 

The microscopic urnnalysis, for life insurance purposes, 
calls for information on the following points: — 

Casts (kind), crystals (kind), epithelium (kind), 
amorphous, other abnormal deposits, pus, blood, mueus. 

A } inch or ^ inch objective, with 1 inch eye-piece will 
render efficient service, and answer all requirements. 



86 LIFE INSURANCE EXAMINATIONS. 

THE URINE AS A DIAGNOSTIC FACTOR. 

Dr. Kernode concludes an article with the above title 
with the following succinct rules, formulated by a Dr. 
Formad, and verified by many investigators: — 

1. Sediment in the urine has no significance unless de- 
posited within twenty-four hours. 

2. Albumin in the urine does not indicate kidney dis- 
ease unless accompanied by tube casts. The most fatal 
form of Bright's disease — contracted kidney — has little 
or no alhumin. 

3. Every crystal in urine, regardless of shape, is a 
phosphate, except the oxalate of lime crystal, which has 
its own peculiar form ; urine alkaline. 

4. Every yellow crystal is uric acid if the urine is acid, 
or a urate if the urine is alkaline. 

5. Mucous casts, pus, and epithelium signify disease 
of the bladder or disease of other parts of the urinary 
tract, as determined by variety of epithelium. 

6. The urine from females can often be differentiated 
from the urine of males by finding in it the tesselated 
epithelium of the vaccina. 

7. Hyaline casts (narrow), blood, a*^d epithelial casts 
sig^nify acute catarrhal nephritis. There is much albumin 
in this condition. 

8. Broad hyaline casts and epithelial casts, dark-^reen 
granules, and oil casts signify chronic catarrhal nephritis. 
At first, much alhumin ; later, less. 

9. Hyaline and pale granular casts, and little or no 
albumin signify interstitial nephritis. 

10. Broad casts are worse than narrow casts, for the 
former signify a chronic disease. 



LIFE INSURANCE EXAMINATIONS. 87 

11. The urine should be fresh for a microscopic ex- 
amination, as the micrococci will change hyaline casts 
into granular casts or devour them entirely in a short time. 

12. Uric acid may, in Trpmmer's test for sugar, form 
a peroxide of copper, this often misleading the examiner 
into the belief that he has discovered sugar. Thus, when 
urine shows only sugar, the other methods of examina- 
tion must be used — preferably the lead test. 

13. The microscope gives us better ideas of the exact 
condition of affairs in examination of urine than the 
various chemical tests. — Tri-State Medical Journal. 

Has the party ever had any severe illness or injury^ or 
undergone a surgical operation ? 

The element of severe illness should call forth the 
name of the ailment, ihe number of attacks, the date, 
the duration, the sever ty, the result, including sequelae, 
and the name and address of the medical attendant. If 
there has been a severe injury, the date and nature of 
the injury should be mentioned, and also how long the 
applicant was disabled. The name of the medical at- 
tendant would also be in order. The record as to a 
surgical operation should be alike specific as to date, and 
for what the operation was performed, with its result and 
remainino; effects, if any. 

Is there any indication that the applicant is not now en- 
tirely loellf 

The importance of this question becomes apparent 
when one reflects on the tendency of the active agent to 
rush his applicants into an examination, in spite of their 
protests that they are ailing slightly. This is looked 
upon by the agent as merely an excuse to get out of clos- 
ing the contract, but the '* cold'* or slight ailment, often 



88 LIFE INSURANCE EXAMINATIONS, 

assumes a greater aspect in the eyes of the examiner, 
who is not called upon to t^ke any chances, either for 
himself in recommenHing an improper risk, or in thereby 
askins: the company to assume an undue hazard. Some 
companies call for a so-called "commercial report" on 
their applicants, and in addition to the financial standing 
this usually embraces a history of the habits, and inci- 
dentally tells of the reputed condition of his health, as 
gleaned among his daily associates. Very frequently, 
cases are postponed because these reports casually men- 
tion that the applicant is just recoverinor from ^rip or 
other illness, and a second examiner is then asked to go 
over the matter, and report upon the reliability of the 
goss^'p, as well as verifv or neg:ative the fact that the 
applicant is artually in groo^ health at the time. 

Is the party deaf, dumb, blinds lame, deformed, or 
maimed in any way? 

In view of the extra hazard involved in the affirmative 
of this question, it behooves the examiner to be on his 
guard, as, if he fails to notice the impairment, he may be 
unpleasantly reminded of his short-sightedness through the 
ubiquitous inspection department, or the "commercial 
report*' mentioned above. 

No deaf mute is regarded as a fit subject for ordinary 
insurance. If deafness becomes apparent, its full history 
must be given, embracing the points mentioned under the 
caption of ear disease. Total blindness is, of course, a 
disqualification, and partial blindness cannot be passed 
upon intelligently without a chronoloorical and pathological 
report. Deformities figure extensively in life-insurance 
records, and are disposed of in accordance with their 
gravity. 



LIFE INSURANCE EXAMINATIONS. 89 

The Manhattan Life Medical Directors say : — 

'' Applicants with a bodily malformation or deformity 
may not necessarily be debarred from life insurance, and 
yet, on the other hand, such malformation or deformity 
may be so conspicuous as to be a bad advertisement for 
the company; or asrain, it may indicate a constitutional 
condition which renders the applicant undesirable, and 
which mav not make itself manifes;t in any other way. 
Such conditions should be closely examined and the facts 
reported.'' 

Is thpre nny indication which lead^ you to suppose that 
the partfi has led or noio leads, other than a temperate 
liff> ; or that the present or past habits are^ or have been, 
faulty in any respect? 

The theme of this inquiry forms the basis of much cor- 
respondence with the home office. The writer recently 
examined a well-known banker whom he had seen almost 
daily for many years, and had regarded as a sober man. 
The * ' Clearing House '* record showed this man's rejection 
several years ago on account of abuse of alcohol. Upon 
being confronted with this, he claimed not to know of 
this rejection, but admitted that he had been examined 
by one company at a time when he was drinking freely, 
*' to drown his sorrow '' over a great financial loss, which 
had practically ruined him. In the meantime, however, 
be had braced up "financially and otherwise," and was 
solvent and sober. 

Is there apparent in the person examined^ any predispo- 
sition, either herpditary\or acquired^ to any local or con- 
stitutional disease 9 

Before answering this question, it is desirable to read 
over the family and^personal history, and discover if any 



90 LIFE INSURANCE EXAMINATIONS. 

taint is observable which would impair the risk. This 
applies particularly to tuberculosis, cancer and syphilis. 

Has the applicant the appearance of an overworked, 
person ? 

The influence of ''work and worry '' leaves a deep im- 
press on the insurance mortality, either directly in so- 
called neurasthenia and other diseases, or indirectly in 
impairing the normal resistance to disease. Hence the 
apprehension of the '* powers that be " at the home ofl3ce, 
which must be quieted before a policy can be issued. 

Do you consider the party's present residence or occupa- 
tion affects his longevity unfavorably? If so^ how and to 
what extent ? 

Before answering this question it would be advisable to 
study carefully the suggestions given before as to resi- 
dence and occui)ation, and form an estimate to correspond 
with the requirements there noted. 

EXAMIXATION OF WOMEN. 

''The examination of female applicants is often attended 
with great difficulty, and it is sometimes almost impos- 
sible to secure a satisfactory representation of their exact 
condition. It is on account of this fact, among others, 
that companies hesitate about accepting them. When 
female applicants are presented for examination the great- 
est care should be exercised to particularly ascertain the 
exact condition, so far as possible, ot their reproductive 
system, in addition to the general facts pertaining to both 
sexes. 

' ' Does she menstruate' regularly and are her catamenia in 
sufficient quantity? If not is the difficulty due to some lo^ 
cat cause ^ or is her general conditiQn at fault? Has sJie, 



LIFE INSURANCE EXAMINATIONS. 91 

any tumors or swellings of any sort? If so, state their lo- 
cation and nature. Is she pregnant? Duration of preg- 
nancy? If yes, she should be postponed until asuflacient 
time has elapsed after labor to establish her usual good 
health. Have her labors visually been ea^y and natural, 
or have they been difficult? Has instrumental delivery 
been necessary? If possible, ascertain the cause. Has 
she passed her climacteric ? If yes, luas that period accom- 
panied by any unusual sym^doms or conditions, either 
physiccd or mental? Has she been, or is she married, or is 
she a widoio? Please give the date of her marriage? '' — 
Manhattan Life Instructions. 

Among the questions asked by various companies, is 
an inquiry as to whether she has been treated for any dis- 
ease of the generative organs. If so, by whom? Any 
disease of the brenst, past or p'-esent? How many children 
has she had? Date of her last confinement? If she is 
nursing, it must be observed what effect, if*any, lactation 
seems to have on her general condition. If the applicant 
is light weight, or the season is summer, a postponement 
is usually ordered until the child has been weaned. The 
husband's occupation is asked by m^ny companies. It 
is also a^ked, '' Is arty one dependent upon you for sup- 
port? If so, sta^e names, and ages on blank space." 

In case a miscarriage is admitted it is well to learn if 
she has since had a labor at fuil term. One company 
asks the question, ^''Are you engaged to be married ivithin 
the next two years ? " 

The statement as to the menopause often brings into 
question the stated age. The writer has occasionally 
been told by an applicant said to be under 50, that she had 
^* the change of life nearly 15 years ago,'* which may be 



92 LIFE INSURANCE EXAMINATIONS. 

possibly true, but the home oflSce usuallv invites the aid 
of the inspection (department at once, in such cases. 

The name and address of the usual meHic^l attendant, 
as well as anv special medical attendant, should be learned 
in all cases of women. Some companies will not is<5ue to 
a married woman unless her husband is also injured in the 
same company. *' A single wonaan is required to ^ive 
satisfactory reasons why insurance is sought and to show 
occupation and condition of health of father, if living." — 
Prudentlnl, 

Some companies issue policies upon female applicants 
with an extra added ; others write onlv restricted policies, 
such as endowment forms; other companies, again, take 
them at same rates as male applicants, but all scan t^em 
closely from the Medical D'rpctor's standpoint, and re- 
quire absolutely select cases before undertakinsr to insure 
them. No examination of a female applicant should be 
undertaken without the removal of her corsets. 

Before completing the examination, some companies in- 
sert an additional question to finally arouse the attention 
of the examiner, so as to obviate errors and omissions. 
For instance, a certain company asks: ^' Have you re- 
viewed all answers in this report and application ; and 
are you sure they are clear and complete.'* Some compa- 
nies do not call for an opinion or classification of the risk 
from the examiner, whereas, other companies ask for an 
opinion based upon a stated gradinof of risks. Among 
the various gradings the following may be cited: Do you 
find the party in perfect health and safely insurable? If 
safely insurable, do vou consider the party a first class 
risk, a good risTc^ or only a fair risk. 

Do you recommend that a policy be issued ? The ma- 



LIFE INSURANCE EXAMINATIONS. 93 

jority of the companies ask for an unreserved expression 
from the examiner as to acceptance or rejection. 

CONFIDENTIAL REPORTS. 

Many Medical Directors, in their " instructions to ex- 
aminers," ask to have information sent direct to the 
home office, which, for any reason, tlie examiner prefers 
not to embody in liis report. 

On this point the advice of the writer is ^' Don't," as 
no matter liuw well-meaning the Medical Director may 
be, the chances are that '' leaks " will occur, so that the 
agency affected by the report will finally learn of it. In 
relation to this matter, the following quotation from a 
well-known Medical Director is apropos: "I desire the 
examiners to be perfectly independent, and to have the 
courage of their convictions, and fearlessly to place upon 
paper their recommendations as to the acceptance or re- 
jection, knowing that they will be protected at all haz- 
ards, just as long as they continue to do their duty." — 
Dr. Frank Wells. 

The question has been mooted as to whether medical 
reports should be returned to the agent. As the agency 
force produces the business, it is natural that it should 
be in close touch and inspire the confidence of the pow- 
ers that control the companies, hence, if the home 
office authorizes the agent to have the medical report, it 
places a trust about which the medical examiner need not 
concern himself. It is never wise to antagonize the ac- 
tion of the home office, and in accepting an examiner- 
ship it is proper to accommodate one's views to the 
discipline prescribed by the rules of the employment 
undertaken. If this cannot be done, it is better to 
resign than to be out of harmony with the employers. 



94 LIFE INSDHANCE E:fcAMINATtONg. 

SUB-STANDARD LIFE INSURANCE. 

A '' sub-standard " or '' under-av« rage '* life may be 
defined as one presenting some impairment, which would 
di-qualify the applicant from obtaiuing insurance at 
ordinary or select rates. 

This disqualification may be by reason of defective 
family history, or may occur in the matter of the per- 
sonal history. 

The number of companies undertaking these risks 
seems to be extending. The effort is made to compen- 
sate for these impairments by putting a "lien" on the 
policy or by charging an '' extia" rate for each impair- 
ment. 

As a guide to the views held by the insurance experts 
on this question, the following items are quoted from the 
ins' ructions of the Security Trust and Life Insurance 
Co., of New York: 

The company entertains applications on all healthy lives. 
The preiniams named are for '^select lives,'' If there be 
an extra risk on account of occupation, family history, 
etc., the premium will be made to correspond. 

If you have doubts about the desirability of a proposer, 
say so frankly. Inspection reveals all these defects, and 
the revelation destroys confidence. 

MEDICAL EXAMINATIONS. 

The regularly commissioned examiners of "this com- 
pany MUST be Used ; in localities where this company has 
not appointed examiners, regularly commissioned exam- 
iners of other " old line " companies may be used. 

A medical examiner's fee of three dollars will in each 
case be paid by the company direct to the examiner. If 



LIFE INSURANCE EXAMINATIONS. 96 

a policy is " not placed," the fee will be charged to the 
general agent, unless the policy issued should be on a 
different plan than originally applied for. 

Opinions upon the insurability of certain proposed risks 
will always be cheerfully given, but to avoid disappoint- 
ment the fullest details should be furnished. 

While no set rules can be laid down as to the action of 
the company on any given class of risks, the following 
may be used as a guide: — 

Albumin. — Only the most favorable cases of albumin- 
uria can be considered. As a rule, no case of persistent 
albuminuria is acceptable; transient or intermittent al- 
buminuria, without the evidence of renal change, will be 
considered. These cases must be in other respects select 
lives. 

In all cases of suspected albuminuria the heart and 
arteries must be examined very carefully for sclerosis, 
and the eyes for premature arcus senilis. 

In all cases where albumin is found in a regular 
examination, or even suspected, a sample of urine pro- 
cured at a different time is to be sent, securely sealed 
and properly labeled, to the designated analyst of the 
company nearest in point of time, for a second chemical 
and microscopical examination, an|cl he will report direct- 
ly to the home offic^e. A pinch of salicylate of sodium 
may be added for the purpose of preserving the sample. 

Alcohqllc Liquors — Propositions from persons who 
use brewed, milt or distilled liquors as a beverage will 
not be considered unless the kind and average, daily 
amount are clearly and specifically set forth. Applica- 
tions containing indefinite and obscure answers on these 
points will be promptly returned. 



96 LIFE INSURANCE EXAMINATIONS. 

Appendicitis. — No applicant who has suffered from 
appendiciiis, where the appendix has not been removed, 
will be considered wituin two years from the date of re- 
covery. When the appendix has been removed, if there 
be no untoward results within one year, the applicant 
will be accepted. The rating for these cases will be from 
select life up, according to the case. If there have been 
recurrent attacks and appendix not removed, three or 
four years must elapse before the applicant can be ac- 
cepted, according to the history of the case. 

Calculus. — In cases of urinary calculus from one to 
two years, according to severity, must elapse before 
applying, and in biliary calculus from two to three years 
must have elapsed, but the company must judge each 
case. 

Cancer. — Cancer in family, unless in several genera- 
tions occurring consecutively, is generally disregarded ; 
but where it appears in the family history in association 
with consumption, applicants will usually be rated up or 
declined. 

Consumption. — No one who has consumption in any 
form will be accepted. 

Epilepsy. — Epileptics are not accepted. 

Fistula. — Recent cases of fistula must be very care- 
fully scrutinized and reported upon in detail to secure 
acceptance. 

Heart. — No application where the applicant is suffer- 
ing from a heart lesion will be considered unless the ex- 
amination has been made by an eximiner regularly desig- 
nated by the Medical Department of this company for 
that; service. 

It is not wor4;h while to forward applications from ap- 



LIFE INSURANCE EXAMINATIONS. 97 

pHcants suffering from valvular heart lesions other than 
mitral stenosis, mitral insufficiencies, aortic stenosis, and 
in these cases compensation must have been completely 
established, the pulse must be full and round, and with- 
out any abnormal qualities, such as intermittency or 
irregularity in rhythm and force. 

Intermittency and irregularity of the heart's action 
without the presence of a valvular lesion, where the nerv- 
ous origin of the irregularity can be distinctly traced, 
may be considered. 

In all cases of heart trouble of any character the pulse 
must be taken and the heart examined, both in repose 
and after vigorous exercise. 

The poHcy of the company is to accept neither the 
young nor the old suffering from heart lesions. 

Unless the lesion can be proven to be congenital, cases 
of valvular disease will not be considered in the young 
until they have reached such an age that compensation 
may be considered to be thoroughly established. 

Hemorrhage. — If from the throat or nose or bronchi, 
will receive consideration, but this must be proven before 
the company will accept. In cases of hemorrhage from 
the lungs a minimum of six years must pass, and the ap- 
plicant must agree to live in a clims^te satisfactory to the 
company. 

Occupation. — See specific '* extras'* for occupation, 
etc. 

Paralysis. — No case in which paralysis has occurred 
after the age of 50 need be presented. 

Peritonitis. — At least one year must have elapsed 
after an attack of peritonitis before an applicant 
will be accepted, the extra then to depend upon 

7 



98 LIFE INSURANCE EXAMINATIONS. 

the individual merits of the case. Nq rate can be pre- 
dicted. 

Prostate. — Permanent enlargement of the prostate 
gland calls for a very high premium where accepted at all. 

Specific Gravity. — Wherever the specific gravity of 
urine is found to be over 1030 or under 1015, sufficient 
examinations must be made to determine the reasons 
therefor, and detailed report made to the company, 
giving hour when passed and hour of examination. 

Sugar. — Cases of transient or intermittent glycosuria 
can be considered, but there must never at any time 
have been present in the applicant any of the rational 
signs of diabetes, such as progressive loss of flesh, per- 
sistent thirst, polyuria, etc. In all cases where sugar is 
present a quantitative test should be made after the 
method of Roberts, Purdy, Fehling, Whitney or some 
other standard test. Should the examiner be unable to 
make this test, a sample must be sent to the home office, 
or to the designated analyst nearest in point of time to 
the place of examination, as in the case of albumin. 

General. — See that all questions are answered defi- 
nitely. No general answer will be accepted, as ^'Mer- 
chant" for occupation, or '' Don't know," without some 
reason being given. 

Realizing that it is impracticable to classify or furnish 
a table of rates for the various impairments upon life 
risks (for each case differs in some respect from every 
other), and that a clearer understanding as to the amount 
of the probable extra may prove helpful, we submit the 
following information: — 

An unfavorable insurance record is 7io bar with this 
company. 



LIFE INSURANCE EXAMINATIONS. 99 

In nine cases out of ten the extra on acceptable cases 
will be from $3 to $7.50 per $1,000. Where double im- 
pairments exist the extra in all probability will be from 
$5 to $10 per $1,000. 

Albumin cases are generally accepted by us at an extra 
•premium of about $8 to $14 per $1,000, unless casts are 
found. 

Sugar cases are similarly rated, provided that applicant 
has none of the other symptoms of diabetes. 

Heart murmurs and irregular pulse at the younger and 
middle ages are insurable with us at an extra of from $10 
to $15, —-preferably on an endowment plan, — but no 
kind of heart trouble is admissible in applicants over 55 
years of age. 

Family History. — Consumption, cancer or any her- 
editary diseai^e in family does not disqualify, but is rated 
according to circumstances. 

Age Limit. — Applicants who are physically select are 
considered up to 6b years of age. 

Liquor dealers can obtain a 20-year endowment at book 
rates if physically select. They can also, however, get 
an ordinary life or limited payment by paying an extra 
premium of from $5 to $10. 

Lien policies, as a rule, can be 3ecured in lieu of extra 
premiums, if so desired. 

EXTRA PREMIUMS. 

Hazardous Occnpatious. 
S. — Select; N. A. — Not Accepted. 

Actor S 

Actress..... Special 

Army Officer (time of peace) !Sr 

LafC. 



100 LIFE INSURANCE EXAMINATIONS. 

Bartender $5.00 to $10.00* 

Saloonkeeper $5.00 to $10.00* 

Bargeman $5. GO to $10.00 

B. B. Player $5.0(1 

Billiard Marker .$5.00 

Bottler $5.00 

Brewer (Prop.) S 

Brewer}^ Emp $2.50 to $7.50 

Bridge Builder $5.00 to $10.00 

Buzz Saw^^er $7.50 to $10.00 

Cartridge Maker N^ A 

Celluloid Worker $10.00 

Circular Sawyer $7.50 to $10.00 

Crucible Steel Worker .$5.00 

Cutlery Finisher.. ^ $5.00 to $10.00 

" Forger] $5.00 to $10.00 

" Grinder $5.00 to $10.00 

'' Polisher $5.00 to $10.00 

Distillery Emp $7.50 

Diver Special 

Driver (beer wagon) $2.50 to $5.00 

Electric Employes Special 

'' Lineman Special 

Explosives .^ $7.50 to $15.00 

File Maker ' $10.00 

Fireman (paiddept.) S. to $5.00 

Fisherman , S. to $10.00 

Glass Blower S. to $5.00 

Gravity R. R. Emp S. to $5.00 

Grin(ier (edged tools) $5.00 

Grocer (bar attached) $5.00 

Hotel Prop, (tending bar) $5.00 

* Saloonkeepers, Bartenders,'etc., Select on Endowment plans. 



LIFE INSURANCE EXAMINATIONS. 101 

Lead Worker $5.00 

Lighterman..... $5.00 

Limestone Burner or Quarrier S. to $10.00 

Marble Worker S. to $10.00 

Miner (coal) $5.00 to $20.00 

" (gold, silver and iron) $2 50 to $7.50 

'' (lead, zinc and copper) $5 00 

Oil MillEmp $5.00 

*' Refinery $5.00 

'^ Well $5.00 

Quarrymen S. to $10.00 

Railroad Brakeman, Construction $10.00 

'' •Freight $10.00 

'' Passenger S 

Car Coupler $12.50 

Conductor, Construction $10.00 

'' Freight $10.00 

" Passenger S 

Construction Train Laborer $10.00 

Engineer, Freight.... $5.00 

" Passenger S 

'' Pumping Station S 

" Switcher $5.00 

Fireman, Freight ' $7 50 

'' Passenger S 

Flagman : $5 00 

Sectionman $5.00 

Signalman $5.00 

Switchman (not in yard) $5.00 

Targetman ...$5.00 

Wrecking Gang $5.00 

Yardman $7.50 



102 LIFE INSURANCE EXAMINATIONS. 

Railroad Yardmaster (active) $10.00 

" '' (supervising) S5.00 

Saloonkeeper, Bartender So. 00 to $10.00* 

Sailor , $5.00 

Slate Quarrier $5.00 

Smelter, Pyritie S 

Lead $10.00 

Stevedore ; $10.00 

Zinc Works Emp N. A 

ODDS A]ND ENDS. 

Keeley Cure applicant: Graduates of the Keeley, or 
otber so-called cures for the drinking habit, must show 
abstinence for at least five years after cure, must be in 
good business ; domestic environment must be all right, 
and the applicant must be in a position where he is owning 
or managing business in some place of responsibility. 

A rapid pulse may be temporary produced by exer- 
cise, the taking of food or stimulants, or the use of 
tobacco, tea or coffee. The cause or stimulus should be 
removed, and the pulse taken under normal conditions 
before closing the case. 

Loss of weight occurring rapidly may indicate the pres- 
ence of some form of pulmonary disease, or of some 
affection of the kidneys. 

Angular curvatures of the spine require close scrutiny, 
as any departure from the normal shape of any part of 
the thorax interferes with a vital operation. 

Erysipelas: State parts affected, as well as tendency 
and frequency of recurrence. 

* Saloonkeepers, Bartenders, etc.. Select on Endowment plans. 



LIFE INSURANCE EXAMINATIONS. 103 

'' Besides the matter of the candidate's physical condi- 
tion, the subject of the sanitation of his environments 
should receive careful consideration at the hands of the 
examiner." Eq. 

^'' Bone caries^ if of any extent, disqualifies during its 
continuance." Eq. 

'' Chancroid^ disqualifies for a term of six months 
after initial appearance" (this is to protect against pos- 
sible errors of diagnosis). 

Delirium Tremens: Any history of delirium tremens, 
whether recent, or in the far past, ordinarily disqualifies 
permanently. 

Pulse: Confirmed over-rapidity (over 90 beats per 
minute) under-rapidity (under 50 beats per minute) of 
the pulse rate, or systematic irregularity of the pulse, 
ordinarily disqualifies during continuance. 

Sunstroke disqualifies for a term, according to the case. 
Recurring attacks may disqualify permanently. 

Cases indicating pregnancy are usually postponed. 
Unusual care is exercised in the selection of female lives 
between the ages from 40 to 50, or until the menopause 
has fully past. 

If the pulse remains persistently over 90 after a due 
amount of rest it will operate as a disqualification. 

If the applicant's figure is ^' spare " or stoop-shoul- 
dered, or is peculiar in any way the particulars should be 
recorded. 

Describe minutely any deformity, malformation ot* in- 
jury. 

One company asks for the measurement from the 
seventh cervical vertebra to the coccyx ; which would 



104 LIFE INSURANCE EXAMINATIONS. 

naturally disclose any curvature of the spine, and call 
attention to the compensator^^ deformity in the chest. 

'' What is not required of an examiner (although, of 
course, gratifying when willingly done) is either to insure 
his own life in the societ3% or to actively influence others 
to do so. " Although the point is obvious, it is well for 
completeness sake to remind the examiner that he should 
refuse service in any case where an adverse result would 
be of concern to himself. He should, therefore, not con- 
sent to examine an intimate friend or a near relative, if 
there be any competent physician available for the case, 
and should, of course, under no circumstances, act as 
examiner for a proposed assurance of which he is to be 
himself, either in whole or in part, the beneficiary. Also, 
it is hardly necessary to add, an examiner should never 
accept any share of the agent's commission, or any other 
consideration of value on a case of his own examining.'* 
Equitable Instructions, 

"Christian Scientists" Not Insurable. — In the 
March issue of the Cleveland Journal of Medicine^ atten- 
tion is called to the fact that the fraternal beneficial 
organization known as the Knights of Honor some months 
ago ruled that persons believing in the doctrines of so- 
called ''Christian Science'' would not thereafter be 
received into membership. "This action was taken 
because it was seen to be reasonable not to take any 
risks upon the lives of persons who refuse to avail them- 
selves of the accumulated knowledge of medical science 
when they are ill. It is now learned that one of the 
greatest and most conservative life insurance companies 
in the world, the Mutual Life Insurance Company of New 



LIFE INSURANCE EXAMINATIONS. 105 

York, without making any parade of the matter refuses 
to issue policies upon the hves of ' Christian Scientists/ 
These facts are not noted to give these organizations 
credit for doing that which common sense and good busi- 
ness policy suggest, but to show the very fact that, 
viewed from the commercial standpoint, the ' Christian 
Scientist ' and faith curist are recognized as persons who 
do not take average care of their lives. For insurance 
purposes they are being classed along with habitual 
drinkers and with those who follow hazardous occupa- 
tions." — Medical Examiner, 

X-Ray IN Life Insurance Examinations. — Dr. F. H. 
Williams (^Boston Medical and Surgical Journcd), says: 
The organs to be considered by life insurance examiners 
in the physical examination of candidates are chiefly the 
kidneys, the lungs, and the heart. Two of these organs — 
the lungs and the heart — are especially open to inspec- 
tion by the X-rays, and can be thus examined without 
removing the clothing. In the lungs, for instance, old 
foci of tuberculosis give rise to abnormal appearances, 
which can be seen on the fluorescent screen, and yet which 
might be overlooked by auscultation and percussion, if 
not near the surface of these organs. Emphj^sema of the 
lungs is best recognized by the X-rays ; the effects of old 
pleuritic adhesions may sometimes be seen by this new 
method of examination, and thoracic aneurisms may be 
detected in an early stage. 

The size and position of the heart can be determined 
with greater certainty and exactness by the X-ray than 
by the older methods. There is no single method of phy- 
sical examination of the thorax, when properly carried 



106 LIFE INSURANCE EXAMINATIONS. 

out, that gives such trustworthy and complete evidence 
of the normal or abnormal condition of the organs in this 
part of the body as an examination with the fluorescent 
screen. From the insurance standpoint it is not so much 
a question of what the disease is, as whether there is or is 
not an abnormal condition in the chest. 



INDEX. 

Accentuation of heart sounds, 42. 
Address of applicant, 11. 
Age, applicant's, 12. 

attained by family members, 25. 
Albumin, 80. 

nitric acid test, 81. 

potassium ferrocyanide test, 81. 
Alkalies, volatile or fixed, in urine, 79. 
Alkaline urine, 79. 
Aibuminometer, Esbaeh's, 81. 
Albuminuria, causes of, 80. 

as affecting risk, 80. 
Alcohol, excessive use of, 21. 
Alcoholism, facies, 18. 

tongue in, 21. 

tremor, 18. 
Anemia, 41. 
Apoplexy, 28. 
Appendicitis, 62. 
Applicant, address of, 12. 

appearance of, 63. , 

examiner's knowledge of, 63. 

identification of, 64. 
Applications pending, 23. 
Arterio-sclerosis, 50. 
Asthma, 28, 38. 
Atavism, 48. 
Birth, date of, 11. 
Bladder diseases, 40. 



108 LIFE INSURANCE EXAMINATIONS. 

Blood, spitting of, 59. 

Brain diseases, 34. 

Blight's disease and occupation, 80. 

Bronchitis, 29. 

Build, 65. 

Calculus, renal, 41, 54. 

Cancer, 29, 96. 

Cardiac abnormality, 55, 60. 

Casts, urinary, 50. 

Centrifuge, the, 76. 

Chest, alar and pseudo-alar, 74. 

examination of, 69. 

form of, 74. 

measurements of, 74. 
Clearing house, the, 23. 
Colic, 30. 

Commercial report, 88. 
Complexion, 64. 
Confidential reports, 93. 
Consumption, 52, 27. 
Convulsions, 47. 
Coughs, prolonged, 32. 
Cystitis, 40. 
Deafness, 88. 
Debility, 45. 
Deformities, 88. 
Diarrhoea (habitual), 44. 
Diseases of the bladder, 40. 
Diseases of the brain, 34. 
Diseases of the ear, 32. 
Diseases of the heart, 34. 
Diseases of the kidneys, 40. 



INDEX. 109 

Diseases of the liver, 39. 
Diseases of the lungs, 36. 

Diseases of the nose and throat, 38. 

Dizziness, 42. 

Dropsy. 43. 

Dyspepsia, 45. 

Dyspnoea, 43. 

Ear, discharge from, 33. 

Edema, in heart disease, 34. 

Endocarditis, 35. 

Environment, tubercular, 27. 

Esbach's solution, 82. 

Examiner's report, 63. 

position and opportunity, 8. 
Famil}^ history, 24. 

cancer, 27. 

consumption, 27. 

examiner's duties in relation tojeporting, 93. 
Fehling's test for sugar, 84. 
Fetor, 38. 
Fistula, 47. 
Fits, 46. 

Form of occupation, 13. 
Form, uses of, 8. ^ 

Gall-stones, 39. 
Glucose, test for, 84. 
Glycosuria, 85, 98. 
Gout as affecting insurability, 47. 
Gravel, 51. 

Habits and intemperance, 19. 
Hair, color of, 64. 
Hay fever, 28. 



110 LIFE INSURANCE EXAMINATIONS. 

Headache, 51. 

Heart, apex-beat of, 35. 
dilatation of, 35. 
palpitation of, 34. 

Height and weight, 65. 

Heller's test for albumin, 81. 

Hemoptysis, 59. 

Hemorrhage, 97. 

Heart murmurs, 35. 

Hepatitis, 40. 

Hernia, 57. 

Holland's Fehling solution, 84. 

Identification, 64. 

Illness, 64. 

Insanity, as affecting aceeptancei 52, 

Inspection department, 18. 

Insurance of sub-standard lives, 94. 
Intemperance and habits, 19. 
Jaundice, 40. 
Keeley cure, 102. 
Kidney, diseases of, 40. 
expression, 42. 
movable, 54. 
Lactation, influence of, 91. 
Laryngitis, 38. 
Lien policies, 99. 
Liver diseases, 39. 
Lives, selection of, 7. 
Lumbago, 54. 
Lumps and swellings, 52. 
Lungs, diseases of, 36. 
examination of, 74. 
expansion of, 74. 



INDEX. 

Malaria, 52. 

Malformations, 88. 

Measurements, chest of, 69. 

Medical examiners* responsibilities, 8. 

report, 63. 
Microscopic uranalysis, 85. 
Movable kidney, 54. 
Mucous casts, 86. 

Murmurs, valvular. See heart murmurs, lb. 
Myocarditis, 35. 

Nephritis. See Bright's diseases, 40. 
Neurasthenia, 49. 
Obesity, 39, 
Occupation, 14. 
former, 16. 
and alcoholic excess, 18, 

Opium, 22. 
. Open sores, 53. 

OrlhopDoea, 29. 

Overweight, 65. 

Oz^na, 38. 

Pain in the back, 54. 

Palpitation, 55. 

Paralysis, 55. ^ 

Pericarditis, 34. 

Peritonitis, 63. 

Phenyl-hydrazln test, 84. 

Phthisis, 59. 

Physical marks, 64. 

Pigeon-breast, 66^ 74. 

Piles, as affecting risk, 56. 

Pleurisy, 37. 



Ill 



112 LIFE INSURANCE EXAMINATIONS. 

Pneumonia, 37. 

Polypi, nasal, 38. 

Potassium ferrocyanid test, 81. 

Pobassio-mercuric iodide test, 82. 

Present occupation, 17. 

Privacy, importance of, in examinations, 63. 

Prostate, 98. 

Pulse and pulse taking, 75. 

Puerperal convulsions, 46. 

Purdy's test, 81. 

Pus in urine, 86. 

Race, 64. 

Eeaction of the urine, 79. 

Rejection, attempts to conceal, 23. 

Renal colic, 54. 

Residence, 12. 

Rheumatism, chronic, 56. 

recurrent, 57. 

alkaline treatment, 79. 
Rupture, 57. 
Scrofula, 58. 
Selection, medical, 7. 
Skin diseases, 58. 
Sores, open, 53. 
Specific gravity of urine, 78. 

in diabetes, 78. 
Spitting of blood, 59. 
Stomach, diseases of, 76. 
Stricture, 59. 

Substandard lives, insurance of, 94. 
Sugar in urine, test for, 84. 

Fehling's, 84. 



INDEX. 113 

Surgical operations, 87. 
Swellings or lamps, 52. 
Swelling of feet, 60. 
Syphilis as affecting risk, 60. 

external signs, 60. 
Tattoo marks, 64. 
Temperature, 45, 53. 
Throat and nose, diseases of, 38. 
Tanret's solution, 22, 82. 
Tobacco, use of, 22. 
Tuberculosis and phthisis as affecting acceptance, 27. 

hemoptysis in, 59. 
Tumors, 30. 
Turbid urine, 80. 
Underweight, 65. — 

Uranalysis, 77. 

microscopic, 85. 
Urinary casts, 86. 
Urination, frequent, 41. 
Urine, albumin in, 80. 

alkaline, 79. 

bile, in, 39. 

epithelium, 86. 

light weight of, 78. 

temperature of freshly voided, 79. 
Urinometer, variations of, 79. 
Varicose veins, 62. 
Vertigo, 42. 
Weight, 66. 
Women, examination of, 90. 



A New Practical Work. 

Willeox's Hrferenee Book 
And Foi^malary. • • • 

Designed for the use of Physicians and Students. 
Containing approved points on emergency work, pre- 
scription writing in hrief, dose, obstetric and other 
tables, and a condensed formulary including only 
formulas of recognized value. Contributions from 
forty St. LiOuis practitioners and teachers. Edited by 
T. A. Hopkins, A. M., M. D. 391 pages, Flexible 
Morocco, Gilt Edge. Xet, SI. 35. 



This little volume appeals to the busy practitioner, 
whose time is too fully taken up to pore over the con- 
tents of voluminous volumes when in search of a little 
quick information, as regards the latest and most ap- 
proved methods of diagnosing and treating many of the 
emergency' cases that he is called upon to treat in his 
daily practice, especially those cases of rare occurrence. 
Great pains have been taken to enlist the co-operation 
of skilled clinicians and teachers. Each contributor has 
taken the subject of his choice ; ^ hence we can confidently 
claim that this is the most authoritative work ever written 
on these subjects. 

OPINIONS OF THE MEDICAL PRESS : 

From Medical Brief. 

We take great pleasure in calling your attention to this 
elegant and valuable work. It is put up in elegant style 

July-3\ iQOi 



for the pocket, in flexible morocco cover. But its great- 
est worth is not in its elegance of cover, but its contents, 
as great pains have been taken to produce a work that will 
be of inestimable value to the student and practitioner. 
The creme of the profession of St. Louis have been its 
contributors, and men of national as well as local reputa- 
tion have contributed to its pages. We bespeak for it 
a hearty welcome throughout the United States. 

From The Stylus. 

A neater appearim^ boo'-?, or one containing more prac- 
tical information in a like compass, would be hard to 
tind. 

From The Inter-State Medical Journal. 

This volume is a mine of valuable information on med- 
ical subjects, and will prove invaluable for quick refer- 
ence. The editor and publisher are both to be congratu- 
lated on the excellent work done. 

From The Clinical Reporter. 

This little volume is one of value to every medical 
practitioner and student. It is clear, concise, to the 
point, and contains just the things you need. Indeed it 
is hard to comprehend how so much information can be 
crowded into so small a space. 



IN PREPARATION. 

DIAGNOSIS OF DISEASES IN IN- 
FANCY AND CHILDHOOD. 

By JOHN ZAHORSKY, M. D., 

Lecturer on Diseases of Children^ Washington University. 
Numerous illustrations, 4 plates in colors. 



JUL 22 1901 








''^iVi^ 






'•^-A^ 



r^-" 



